Renal Insufficiency and Heart Failure

McAlister, Finlay A.; Ezekowitz, Justin A.; Tonelli, Marcello; Armstrong, Paul W.

doi:10.1161/01.cir.0000116764.53225.a9

Cited by 635 publications

(229 citation statements)

References 40 publications

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“…they tended to be slightly younger, were less likely to be women, had a higher prevalence of previous HF and a lower LVEF, compared to the patients enrolled in some [10][11][12] but not other [13][14][15][16][17] previous larger studies, several of which included only patients ≥ 65 years. The prevalence of concomitant diseases and, namely, of previous chronic renal failure as well as the s-Cr, BUN and eGFR values on admission of our patients were similar to those in previous studies [5,[9][10][11][12][13][14][15][16][17].…”

Section: Patient Characteristicssupporting

confidence: 88%

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Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Metra

Nodari

Parrinello

et al. 2008

European J of Heart Fail

342

251

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Background: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF). Methods and results: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a ≥25% and a ≥ 0.3 mg/dL increase in serum creatinine (s-Cr) from admission (WRF-Abs-%). Results: Patients were followed for 480 ± 363 days. Fifty-three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF-Abs-% occurred in 107 (34%) patients. At multivariable survival analysis, WRF-Abs-% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13-1.81; p = 0.024). The independent predictors of WRF-Abs-%, evaluated using multivariable logistic regression, were history of chronic kidney disease (p = 0.002), LV ejection fraction (p = 0.012), furosemide daily dose (p = 0.03) and NYHA class (p = 0.05) on admission. Conclusion: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.

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Section: Patient Characteristicssupporting

confidence: 88%

“…Renal dysfunction is a frequent finding in patients with heart failure (HF) and is a powerful independent prognostic factor for adverse outcomes [1][2][3][4][5][6][7][8]. Its prevalence increases in patients with more severe HF.…”

Section: Introductionmentioning

confidence: 99%

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Metra

Nodari

Parrinello

et al. 2008

European J of Heart Fail

342

251

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“…Additionally, the increased risk of bleeding may be due to platelet dysfunction, prolonged bleeding time, and small vessel disease associated with CKD 27, 28. Overall, CKD may be associated with adverse outcomes in HF, as it is a marker of more severe HF, greater symptom burden, and/or coexistent disease 1, 2, 29. The poorer survival in patients with CKD and HF may also reflect the reduced likelihood of being prescribed evidence‐based therapies,29, 30 as CKD is often viewed as a contraindication to some therapies,2, 29 including thromboprophylactic therapies 31.…”

Section: Discussionmentioning

confidence: 99%

“…Heart failure (HF) and chronic kidney disease (CKD) often coexist 1, 2, 3. Among HF patients with concomitant CKD, mortality and morbidity are high 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

et al. 2018

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AimsThe aim of this study was to assess the prognostic value of chronic kidney disease (CKD) in relation to ischaemic stroke, intracranial haemorrhage, major bleeding, and all‐cause death in heart failure patients without atrial fibrillation.Methods and resultsIn this observational cohort study, heart failure patients without atrial fibrillation were identified using Danish nationwide registries. Risk of stroke, major haemorrhage, and death were calculated after 1 and 5 years to compare patients with and without CKD, ±dialysis [dialysis: CKD with renal replacement therapy (CKD‐RRT); no dialysis: CKD‐no RRT]. A total of 43 199 heart failure patients were included, among which 0.8% had CKD‐RRT and 5.9% had CKD‐no RRT. When compared with heart failure patients without CKD, both CKD‐RRT and CKD‐no RRT were associated with a higher 5 year rate of major bleeding (CKD‐RRT: adjusted hazard ratio (aHR): 2.91, 95% confidence interval (CI): 2.29 to 3.70; CKD‐no RRT: aHR: 1.28, 95% CI: 1.13 to 1.45) and all‐cause death (CKD‐RRT: aHR: 2.40, 95% CI: 2.07 to 2.77; CKD‐no RRT: aHR: 1.63, 95% CI: 1.55 to 1.73). For the endpoints of ischaemic stroke and intracranial bleeding, only CKD‐no RRT was associated with significantly higher 5 year rates (ischaemic stroke: aHR: 1.31, 95% CI: 1.13 to 1.52; intracranial haemorrhage: aHR: 1.66, 95% CI: 1.04 to 2.65).ConclusionsCompared with patients without CKD, among incident heart failure patients without atrial fibrillation, CKD both with and without dialysis was associated with a higher rate of major bleeding and all‐cause death. Only CKD‐no RRT was associated with a higher rate of ischaemic stroke and intracranial bleeding.

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“…Previous population‐based studies support our findings. In a study of 754 heart failure patients, survival was significantly tied to renal insufficiency with increased mortality associated with worsening renal dysfunction ( P = 0.002) 16. Additionally, reduced GFR was associated with an increased risk of cardiovascular death and heart failure hospitalizations in 2680 North American patients with systolic and DD 17.…”

Section: Discussionmentioning

confidence: 99%

The renal–cardiac connection in subjects with preserved ejection fraction: a population based study

2017

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AimsChronic kidney disease (CKD) is prevalent and is associated with increased cardiovascular morbidity and mortality. The interaction between diastolic dysfunction (DD) and CKD in subjects with preserved systolic function is not well defined. This study sought to determine the association between renal function and DD in subjects with preserved ejection fraction.Methods and resultsThrough the Rochester Epidemiology Project, subjects who underwent echocardiography over 2 years with EF ≥50% were identified and the clinical data were obtained. Glomerular filtration rate (GFR) was estimated using the modification of diet in renal disease equation. Linear regression was used to test for association of GFR and DD. DD was defined as follows: Grade 2 or pseudonormal pattern (0.75 < E/A ≤ 1.5, E/e′ ≥ 10, DT > 140 ms, ΔE/A ≥ 0.5, and PV S < D) or Grade 3+ or restrictive pattern (E/A > 1.5, E/e′ ≥ 10, DT < 140 ms, and PV S < D). Cox regression was used to assess correlation of GFR and DD with time‐to‐event outcomes. A total of 2056 patients were identified. There was significant correlation between worsening GFR and degree of DD assessed by echo Doppler E/e′ ratio (P = 0.005), left ventricular mass index (P = 0.004), and right ventricular systolic pressure (P = 0.01). Worsening GFR was associated with increased mortality, development of heart failure, and hospitalization (P < 0.001). Within each GFR group, abnormal DD was associated with a higher risk of the clinical outcomes. No interaction between GFR and DD was noted, suggesting an increased risk of events associated with abnormal DD across ranges of GFR.ConclusionsWorsening GFR was associated with a greater degree of diastolic dysfunction and adverse clinical outcomes. Within each GFR group, the presence of DD was associated with increased morbidity and mortality. Further studies are warranted to determine if improving DD in patients with CKD will benefit clinical outcomes.

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Renal Insufficiency and Heart Failure

Cited by 635 publications

References 40 publications

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

The renal–cardiac connection in subjects with preserved ejection fraction: a population based study

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