Heart failure in Nigerian hypertensive patients: the role of renal dysfunction

Obasohan, A. O.; Ajuyah, C. O.

doi:10.1016/0167-5273(95)02469-7

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…Although CKD has been a known risk factor for mortality among patients with heart failure, the findings of al-Ahmad et al were unexpected, as a contribution of anemia to the risk of death had not been previously reported (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). It is possible that the association between anemia and mortality observed in this clinical trial was a consequence of selection of patients for SOLVD, and similar results might not pertain in a more general population of heart failure patients.…”

contrasting

confidence: 46%

Anemia and Renal Insufficiency Are Independent Risk Factors for Death among Patients with Congestive Heart Failure Admitted to Community Hospitals

McClellan¹,

Flanders²,

Langston³

et al. 2002

Journal of the American Society of Nephrology

424

304

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Abstract. The purpose of this retrospective cohort study was to examine the associations among chronic kidney disease, anemia, and risk of death among patients with heart failure. Retrospective cohort study. Patients with a principal diagnosis of heart failure (ICD9 codes 402. 01, 402.11, 402.91, 404.01, 404.11, 404.91, and 428.xx) were included. Chronic kidney disease (CKD) was defined as a serum creatinine Ͼ1.4 mg/dl for women and Ͼ1.5 mg/dl for men. There were 665 eligible patients in the sample with a mean (SD) age of 75.7 (10.9) yr; 60% were women, 71% were white, and 38% had CKD. On admission, a hematocrit Ն40% was found for 30.3% of the patients; 22.9% had a hematocrit between 36% and 40%, 33.2% between 30% and 35%, and 13.6% had a hematocrit of Ͻ30%. The 1-yr death rates among individuals with and without CKD were 44.9% and 31.4%, respectively (relative risk [RR], 1.43; 95% confidence interval [CI], 1.17 to 1.75). The mortality at 1 yr was 31.2% for individuals with a hematocrit Ն40%; 33.8% (RR, 1.08; 95% CI. 0.79 to 1.47) for hematocrit 36 to 39%; 36.7% (RR, 1.17; 95% CI, 0.89 to 1.54) for hematocrit between 30 and 35%; and 50.0% (RR, 1.60; 95% CI, 1.19 to 2.16) for those with a hematocrit Ͻ30% ( 2 for trend was 7.37; P ϭ 0.007). Both hematocrit and serum creatinine were independently associated with increased risk of death during follow-up after controlling for other patient risk factors. In conclusion, CKD and anemia are frequent among older patients with heart failure and are independent predictors of subsequent risk of death.Anemia is a frequent complication of chronic kidney disease (CKD) and is primarily due to failure of erythropoietin production to respond to decreased hemoglobin concentration (1,2). The onset of anemia during the progression of CKD is variable, but it is common after serum creatinine reaches 1.5 mg/dl and increases in prevalence with decreasing creatinine clearance (3,4). At the onset of end-stage renal disease (ESRD), the mean hematocrit is Ͻ30%, despite the use of erythropoietin replacement in over a quarter of new patients (5). A recent report by al- Ahmad et al. (6) found that CKD and anemia are independent risk factors for mortality among patients with heart failure due to left ventricular dysfunction (i.e., an ejection fraction Յ35%) enrolled in the Studies of LV Dysfunction (SOLVD) clinical trial. Increased risk of death was noted among patients with a hematocrit between 35 and 39% as well as those with more severe degrees of anemia. This report is of particular interest given that the prevalence of heart failure was 33% among new ESRD patients (5).Although CKD has been a known risk factor for mortality among patients with heart failure, the findings of al-Ahmad et al. were unexpected, as a contribution of anemia to the risk of death had not been previously reported (7-16). It is possible that the association between anemia and mortality observed in this clinical trial was a consequence of selection of patients for SOLVD, and similar results might not pertain in a more...

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contrasting

confidence: 46%

Anemia and Renal Insufficiency Are Independent Risk Factors for Death among Patients with Congestive Heart Failure Admitted to Community Hospitals

McClellan¹,

Flanders²,

Langston³

et al. 2002

Journal of the American Society of Nephrology

424

304

View full text Add to dashboard Cite

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“…Obasohan and Ajuyah [10] in the Niger-Delta area of Nigeria found renal impairment in 55% of patients in hypertensive heart failure. This lower prevalence might be attributed to the use of creatinine levels above 1.5 mg/dL to define renal dysfunction instead of a cut-off point for GFR as used in this study.…”

Section: Discussionmentioning

confidence: 99%

“…The association between cardiac failure and chronic kidney disease is well established and referred to as the cardiorenal syndrome by some authors [9]. Obasohan and Ajuyah [10] had earlier reported from the Niger-Delta area of Nigeria that renal dysfunction is independently associated with the development of cardiac failure in hypertensive patients. There are no reports known to the authors on chronic kidney disease in patients with cardiac failure in the South Eastern part of Nigeria.…”

Section: Introductionmentioning

confidence: 99%

Renal Function in Patients with Hypertension Associated Congestive Cardiac Failure Seen in a Tertiary Hospital

Osuji

Nwaneli

Onwubere

et al. 2012

International Journal of Nephrology

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Background. Chronic kidney disease is frequently seen in patients with congestive cardiac failure and is an independent risk factor for morbidity and mortality. The aim of this study was to determine the prevalence of chronic kidney disease in patients with hypertension associated congestive cardiac failure. Method. One hundred and fifty patients with hypertension associated congestive cardiac failure were recruited consecutively from the medical outpatient department and the medical wards of the Nnamdi Azikiwe University Teaching Hospital Nnewi over a one year period, January to December 2010. Patients' biodata and medical history were obtained, detailed physical examination done and each patient had a chest X-ray, 12 lead ECG, urinalysis, serum urea and creatinine assay done. Ethical clearance was obtained from the Ethical Review Board of our institution and data analysed using SPSS-version 16. Results. There were 86 males and 64 females with mean age 62.7 ± 12.5 years. The mean blood pressures were systolic 152.8 ± 28.5 mmHg and diastolic 94.3 ± 18 mmHg. 84.7% had blood pressure ≥140/90 mmHg on presentation. The mean GFR was 70.1 ± 31.3 mls/min. 76% of subjects had GFR <90 mls/min and no statistical significant difference between males and females, P = 0.344. The mean serum urea was 7.2 ± 51 mmol/L while the mean serum creatinine was 194 ± 416.2 mmol/L. Conclusions. This study has demonstrated that majority of patients presenting with hypertension associated congestive cardiac failure have some degree of chronic kidney disease.

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Congestive Heart Failure in Nigerians: A Review

Sofowora

Ajayi²

2015

Management of Heart Failure

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Heart failure in Nigerian hypertensive patients: the role of renal dysfunction

Cited by 6 publications

References 11 publications

Anemia and Renal Insufficiency Are Independent Risk Factors for Death among Patients with Congestive Heart Failure Admitted to Community Hospitals

Anemia and Renal Insufficiency Are Independent Risk Factors for Death among Patients with Congestive Heart Failure Admitted to Community Hospitals

Renal Function in Patients with Hypertension Associated Congestive Cardiac Failure Seen in a Tertiary Hospital

Congestive Heart Failure in Nigerians: A Review

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