Prevalence, predictors and prognostic value of acute impairment in renal function during intensive unloading therapy in a community population hospitalized for decompensated heart failure
| Autor: | Cristina Opasich, Donatella Del Sindaco, Francesco Furlanello, Giovanni Cioffi, Andrea Dilenarda, Giovanni Pulignano, Luigi Tarantini, Carlo Stefenelli, Stefania De Feo |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Nitroprusside
medicine.medical_specialty Vasodilator Agents medicine.medical_treatment Renal function Hospitals Community chemistry.chemical_compound Furosemide Risk Factors Internal medicine Humans Medicine Prospective Studies Renal Insufficiency Diuretics Prospective cohort study Aged Aged 80 and over Heart Failure Heart transplantation Creatinine business.industry General Medicine Odds ratio medicine.disease Treatment Outcome chemistry Heart failure Cardiology Diuretic Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of Cardiovascular Medicine. 8:419-427 |
| ISSN: | 1558-2027 |
| DOI: | 10.2459/01.jcm.0000269715.95317.33 |
| Popis: | Background and methods Chronic heart failure (CHF) is often associated with impaired renal function. Diuretics and vasodilators may lead to aggravated renal dysfunction (ARD), particularly among patients with decompensated CHF. Although the prevalence of ARD has been evaluated in patients awaiting heart transplantation, little is known about ARD in the community sample of CHF patients. Accordingly, we prospectively assessed the prevalence, predictors and prognostic value of ARD in 79 consecutive patients admitted to our general community hospital for decompensated CHF undergoing intensive unloading therapy (intravenous nitroprusside and furosemide). ARD was defined as a >or= 25% increase in serum creatinine between admission and maximal value of >or= 2 mg/dl. Results Sixteen patients (20%) developed ARD with a mean increase in serum creatinine of 31% (from 1.74 +/- 0.6 to 2.27 +/- 0.9 mg/dl). ARD persisted at 8-day evaluation in seven of 16 subjects (44%) whereas it was reversible in nine (56%). Lower creatinine clearance at baseline [exp beta = 0.93, 95% confidence interval (CI)=0.87-0.99] and the higher dose of furosemide (exp beta=1.02, 95% CI=1.01-1.03) emerged as independent predictors of ARD. During a follow-up of 11 +/- 8 months, death and hospitalization for worsening CHF occurred more frequently in ARD than non-ARD patients (69% versus 17%, P=0.0001; 69% versus 29%, P=0.003, respectively). Persistent ARD was a powerful independent predictor of long-term adverse outcome (odds ratio=11.1; 95% CI=1.12-36.1; P=0.04). Conclusions Intensive unloading therapy is associated with the development of ARD in one-fifth of the community population hospitalized for decompensated CHF. The magnitude of this phenomenon is not greater than that observed in younger selected populations with advanced CHF, and depends on baseline renal function and increased diuretic dosage. ARD persisting after 8 days from starting intensive unloading is a powerful predictor of subsequent worsened clinical outcome. |
| Databáze: | OpenAIRE |
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