Abstract 11011: The Importance of Serial Renal Function Measurements in Chronic Heart Failure
Background: Impaired renal function is a strong prognostic factor in chronic heart failure (CHF). However, clinical impact of worsening renal function (WRF) has not been rigorously examined.
Purpose: The purpose of this study was to determine the importance of serial measurements of renal function and compare the prognostic significance with exercise capacity and cardiac function.
Methods and Results: A total of 542 consecutive patients admitted to our hospital because of wersening heart failure (455 males, 61±14 years) were enrolled. All patients underwent cardiopulmonary exercise testing and echocardiography before discharge. Estimated GFR (eGFR) by the MDRD formula was mesured at discharge (baseline) and 6 months later. We defined lower limit of eGFR as 60 mL/min/1.73m2and patients were devided into 4 groups by changes in eGFR from baseline to 6 months. These were Group 1: normal to normal eGFR (n=234), Group 2: reduced to normal eGFR (n=42), Group 3: normal to reduced eGFR (n=55) and Group 4: reduced to reduced eGFR (n=211). Primary endpoints were rehospitalization due to worsening heart failure and cardiac deaths. Hazard ratios relative to Group 1 were 2.265 (P< 0.05) in Group 2, 4.055 (P<0.001) in group 3 and 3.974 (P<0.001) in group 4. The Cox proportional hazard regression models determined which variables were associated with cardiac event including cardiac deaths. In multivariate analysis, log BNP (hazard ratio (HR): 1.736, P<0.001), peak VO2 (HR: 0.836, P<0.01), decerelation time (HR: 0.996, P<0.05), sodium (HR: 0.917, P<0.05), eGFR<60 mL/min/1.73m2 at 6 months (HR: 1.854, P<0.05), but not eGFR at discharge, were independent predictors for cardiac events.
Conclusions: Changes in renal function by serial measurements are important for the assessment of risk in CHF.
- © 2011 by American Heart Association, Inc.