Impaired renal function affects clinical outcomes and management of patients with heart failure

Abstract

AimsInpatients with heart failure and renal impairment have poor outcomes and variable quality of care. We investigate treatment practice and outcomes in an unselected real‐world cohort using historical creatinine measurements.Methods and resultsAdmissions between 1/4/2013 and 30/4/2015 diagnosed at discharge with heart failure were retrospectively analysed. Stages of chronic kidney disease (CKD) and acute kidney injury (AKI) were calculated from creatinine at discharge and 3–12 months before admission. We identified 1056 admissions of 851 patients (mean age 76 years, 56% Caucasian, 36% with diabetes mellitus, 54% with ischaemic heart disease, and 57% with valvular heart disease). CKD was common; 36%—Stage 3a/b, 11%—Stage 4/5; patients were older, more often diabetic, with higher potassium, lower haemoglobin, and more oedema but similar prevalence of left ventricular systolic dysfunction (LVSD) compared patients with Stages 0–2. AKI was present in 17.0% (10.4%—Stage 1, 3.7%—Stage 2, and 2.9%—Stage 3); these had higher potassium and lower haemoglobin than patients with no AKI. Length of stay was longer in Stage 4/5 CKD [11 days; P = 0.008] and AKI [13 days; P = 0.006]. Mortality was higher with Stage 4/5 CKD (13.8% compared with 7.7% for Stages 0–2 CKD (P = 0.036)] and increased with AKI (5%—no AKI, 20.9%—Stage 1, 35.9%—Stage 2, and 48.4%—Stage 3; P < 0.001). Adjusted for age, diabetes, and LVSD, both AKI and Stage 4/5 CKD were independent predictors of in‐hospital mortality. In survivors with LVSD, the discharge prescription of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers decreased with progressive CKD, [84%—no‐mild, 59%—moderate, and 36%—severe CKD; P < 0.001]; this was not purely explained by hyperkalaemia.ConclusionsInpatients with heart failure and renal impairment, acute and chronic, failed to receive recommended therapy and had poor outcomes.

Relationship of the ORBIT and HAS-BLED scores with Killip class 3-4 in patients with ST-segment elevation myocardial infarction

“…The mortality and re-hospitalization rate of HF patients with renal insufficiency have remarkably increased compared with those of HF patients with normal renal function. [16–18] A study found that ACS patients with poor renal function tended to have a higher Killip class. [19] HF is also closely related to age.…”

Highlights in heart failure

“…101,102,188,189 The contribution of comorbidities to patients' outcomes may be similar in patients with HFrEF, compared with those with HFpEF, 189 or be larger in those with HFpEF according to other analyses. 132 The most frequent noncardiac comorbidities include chronic kidney disease, 21,32,134,[190][191][192][193] , chronic obstructive pulmonary disease, 194 central nervous system abnormalities, 195 sleep disordered breathing, 196,197 diabetes mellitus, 65,198,199 cancer, 188,200 and iron deficiency. 60,61,63,201 They were all shown to have a major impact on clinical presentation, response to treatment and outcomes.…”

Management of Acute Admissions of Heart Failure Patients with Kidney Disease

“…In an unselected real-world cohort of 1056 admissions of 851 patients with acute HF, the prevalence of CKD stage 3A/B (moderate) was 36% whilst stage 4/5 (severe) was 11%. 2 Importantly, both severe CKD and acute kidney injury (AKI) were associated with greater inpatient mortality and length of stay compared to patients who had no or mild CKD (stage 0-2). 2 In a large meta-analysis (excluding registry studies), the prevalence of CKD at baseline was associated with higher mortality, 16% versus 11%; unadjusted odds ratio (OR) for mortality of 2.34 (95% confidence interval [CI] 2.20-2.50; P=0.001).…”