Abstract P013: Prevalence and Prognostic Impact of Kidney Dysfunction among Patients with Acute Decompensated Heart Failure in Community: The ARIC Community Surveillance
Introduction: Several studies reported that kidney dysfunction is prevalent and is associated with poor prognosis in patients with acute decompensated heart failure (ADHF). However, most of these reports were from clinical trials or a single hospital, limiting their generalizability to clinical practice in the community.
Methods: We tackled these questions using data from community-based surveillance for ADHF conducted as a part of the ARIC Study from 2005 to 2009 for residents aged ≥55 years in 4 US communities (Jackson, Mississippi; Washington County, Maryland; Minneapolis, Minnesota; and Forsyth County, North Carolina). All analyses were weighted to account for the stratified sampling design. The association of kidney function with mortality (in-hospital, 28-day, and 1-year) was assessed using logistic regression. The CKD-EPI equation with worst serum creatinine during hospitalization was used to calculate estimated glomerular filtration rate (eGFR), and persons from nonblack and nonwhite racial groups or with missing key variables were excluded.
Results: Among 10,450 sampled hospitalizations, 3,651 ADHF events adjudicated as definite or probable were included in this analysis, corresponding to weighted 17,378 events after applying sample weights (average length of stay, 8.3 days). The prevalence of reduced eGFR (defined as <60 ml/min/1.73m2) was 83.4% overall, and 37.7% of ADHF cases had eGFR <30. Lower eGFR, particularly eGFR <30, was significantly associated with higher mortality during hospitalization or 1 year of follow-up independently of potential confounders (Table). The association was largely consistent across demographic and clinical subgroups.
Conclusion: Severely reduced eGFR (<30 ml/min/1.73m2) was observed in ~38% of ADHF cases during hospitalization and was a strong predictor of poor prognosis during hospitalization or after discharge in community. These findings suggest that ADHF patients with kidney dysfunction warrant special attention in the management for ADHF.
Author Disclosures: K. Matsushita: None. N. Hyun: None. S.K. Agarwal: None. L.R. Loehr: None. H. Ni: None. P.P. Chang: None. L.M. Wruck: None. J. Coresh: None. W.D. Rosamond: None.
- © 2014 by American Heart Association, Inc.