Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study.

Abstract

BACKGROUND:

The prevalence, prognostic import, and impact of renal insufficiency on the benefits of ACE inhibitors and beta-blockers in community-dwelling patients with heart failure are uncertain.

METHODS AND RESULTS:

We analyzed data from a prospective cohort of 754 patients with heart failure who had ejection fraction, serum creatinine, and weight measured at baseline. Median age was 69 years, and 43% had an ejection fraction > or =35%. By the Cockcroft-Gault equation, 118 patients (16%) had creatinine clearances < or =30 mL/min and 301 (40%) had creatinine clearances between 30 and 59 mL/min. During follow-up (median 926 days), 385 patients (37%) died. Even after adjustment for all other prognostic factors, survival was significantly associated with renal function (P=0.002) in patients with either systolic or diastolic dysfunction; patients exhibited a 1% increase in mortality for each 1-mL/min decrease in creatinine clearance. The associations with 1-year mortality reductions were similar for ACE inhibitors (OR 0.46 [95% CI 0.26 to 0.82] versus OR 0.28 [95% CI 0.11 to 0.70]) and beta-blockers (OR 0.40 [95% CI 0.23 to 0.70] versus OR 0.41 [95% CI 0.19 to 0.85]) in patients with creatinine clearances <60 mL/min versus > or =60 mL/min, although these drugs were used less frequently in patients with renal insufficiency.

CONCLUSIONS:

Renal insufficiency is more prevalent in patients with heart failure than previously reported and is an independent prognostic factor in diastolic and systolic dysfunction. ACE inhibitors and beta-blockers were associated with similar reductions in mortality in patients with and without renal insufficiency.

• Authors: Finlay A McAlister, Justin Ezekowitz, Marcello Tonelli, Paul W Armstrong
• Journal: Circulation (Circulation) Vol. 109 Issue 8 Pg. 1004-9 (Mar 02 2004) ISSN: 1524-4539 [Electronic] United States
• PMID: 14769700 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Cardiovascular Agents
• Creatinine
• Aspirin

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Aged, 80 and over
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Aspirin (therapeutic use)
• Cardiovascular Agents (therapeutic use)
• Cohort Studies
• Creatinine (blood)
• Female
• Heart Failure (complications, drug therapy)
• Humans
• Kidney Failure, Chronic (complications, epidemiology)
• Male
• Middle Aged
• Prevalence
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Stroke Volume
• Survival Analysis