doi: 10.1161/01.CIR.0000158131.78881.D5
(Circulation. 2005;111:1270-1277.)
© 2005 American Heart Association, Inc.
Heart Failure |
Race and Renal Impairment in Heart Failure
Mortality in Blacks Versus Whites
From the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (G.L.S., J.M.F., S.S.R., H.M.K.); General Internal Medicine Section, Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (M.G.S.); Department of Medicine, University of California, San Francisco, Calif (M.G.S.); Division of Cardiology, Denver Health Medical Center, Denver, Colo (E.P.H., F.A.M.); Division of Cardiology, University of Colorado Health Sciences Center, Denver, Colo (E.P.H., F.A.M.); Division of Geriatric Medicine, University of Colorado Health Sciences Center, Denver, Colo (E.P.H., F.A.M.); Colorado Foundation for Medical Care, Aurora, Colo (F.A.M.); Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Ga (W.M.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn (J.M.F., H.M.K.); Robert Wood Johnson Clinical Scholars Program, New Haven, Conn (H.M.K.); Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (H.M.K.).
Correspondence to Dr Harlan Krumholz, Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, Sterling Hall of Medicine (SHM), I-Wing, Suite 456, 333 Cedar St, New Haven, CT 06520. E-mail harlan.krumholz{at}yale.edu
Received October 1, 2004; revision received January 24, 2005; accepted January 26, 2005.
Background— Renal impairment is an emerging prognostic indicator in heart failure (HF) patients. Despite known racial differences in the progression of both HF and renal disease, it is unclear whether the prognosis for renal impairment in HF patients differs by race. We sought to determine in HF patients the 1-year mortality risks associated with elevated creatinine and impaired estimated glomerular filtration rate (eGFR) and to quantify racial differences in mortality.
Methods and Results— We retrospectively evaluated the National Heart Care Project nationally representative cohort of 53 640 Medicare patients hospitalized with HF. Among 5669 black patients, mean creatinine was 1.6±0.9 mg/dL, and 54% had an eGFR 
60, compared with creatinine 1.5±0.7 mg/dL and 68% eGFR 60 in 47 971 white patients. Higher creatinine predicted increased mortality risk, although the magnitude of risk differed by race (interaction P=0.0001). Every increase in creatinine of 0.5 mg/dL was associated with a >10% increased risk in adjusted mortality for blacks, compared with >15% increased risk in whites (interaction P=0.0001), with the most striking racial disparities at the highest levels of renal impairment. Depressed eGFR showed similar racial differences (interaction P=0.0001).
Conclusions— Impaired renal function predicts increased mortality in elderly HF patients, although risks are more pronounced in whites. Distinct morbidity and mortality burdens in black versus white patients underscore the importance of improving patient risk-stratification, defining optimal therapies, and exploring physiological underpinnings of racial differences.
Key Words: ethnic groups • kidney • heart failure • mortality
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