Abstract 9207: Distinct Prognostic Factors in Patients with Chronic Heart Failure and Chronic Kidney Disease
Background: In chronic heart failure (CHF), impaired renal function is a strong predictor of mortality. However, the impact of chronic kidney disease (CKD) on prognostic factors in CHF has not been rigorously examined.
Purpose: The purpose of this study was to compare prognostic factors between CHF patients with and without CKD.
Methods: Consecutive 505 patients with CHF (226 males, age 60±14 years) who performed cardiopulmonary exercise testing before discharge were enrolled. Patients were divided into two groups: CKD group (estimated GFR<60 mL/min/1.73m2, n=213) and non-CKD group (estimated GFR>60 mL/min/1.73m2, n=292). Patients were followed up to register cardiac events including cardiac deaths and re-hospitalization due to worsening heart failure.
Results: Patients with CKD had lower hemoglobin concentration, higher uric acid concentration, higher plasma brain natriuretic peptide levels, lower left ventricular ejection fraction, larger left atrium volumes, higher E/E’ rario, lower peak heart rate, lower peak VO2, and higher VE/VCO2 slope than those without CKD (P<0.01, for each). There were 115 events during follow-up period (746±238days), and cardiac event rate was higher in CKD group than in non-CKD group (34% vs. 14%, P<0.001). In non-CKD group, multivariate Cox hazard analysis demonstrated that body mass index (hazard ratio (HR): 0.532, 95% confidence interval (CI): 0.322-0.879, P<0.001), log BNP (HR: 3.300, CI: 1.634-6.661, P<0.001), left atrial dimension (HR: 1.318, CI: 1.105-1.573, P<0.05) and peak VO2 (HR: 0.743, CI: 0.557-0.956, P<0.05) were independent parameters to predict cardiac events after discharge. In contrast, serum concentration of sodium (HR: 0.876, CI: 0.767-0.999, P<0.05), uric acid (HR: 1.345, CI: 1.062-1.705, P<0.05), log BNP (HR 2.364, CI: 1.404-3.980, P<0.001) and peak VO2 (HR: 0.742, CI: 0.631-0.874, P<0.001) were independent prognostic factors in CKD group.
Conclusions: Prognostic factors were different between CHF patients with and without CKD, and this should be considered to manage CHF patients with CKD.
- © 2011 by American Heart Association, Inc.