Cargando…

Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All‐Cause Mortality in Acute Decompensated Heart Failure

BACKGROUND: Renal impairment is a common comorbidity and the strongest risk factor for poor prognosis in acute decompensated heart failure (ADHF). In clinical practice, renal function is labile during episodes of ADHF, and often worsens after discharge. The significance of worsening of renal functio...

Descripción completa

Detalles Bibliográficos
Autores principales: Ueda, Tomoya, Kawakami, Rika, Sugawara, Yu, Okada, Sadanori, Nishida, Taku, Onoue, Kenji, Soeda, Tsunenari, Okayama, Satoshi, Takeda, Yukiji, Watanabe, Makoto, Kawata, Hiroyuki, Uemura, Shiro, Saito, Yoshihiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338704/
https://www.ncbi.nlm.nih.gov/pubmed/25370599
http://dx.doi.org/10.1161/JAHA.114.001174
_version_ 1782481257869869056
author Ueda, Tomoya
Kawakami, Rika
Sugawara, Yu
Okada, Sadanori
Nishida, Taku
Onoue, Kenji
Soeda, Tsunenari
Okayama, Satoshi
Takeda, Yukiji
Watanabe, Makoto
Kawata, Hiroyuki
Uemura, Shiro
Saito, Yoshihiko
author_facet Ueda, Tomoya
Kawakami, Rika
Sugawara, Yu
Okada, Sadanori
Nishida, Taku
Onoue, Kenji
Soeda, Tsunenari
Okayama, Satoshi
Takeda, Yukiji
Watanabe, Makoto
Kawata, Hiroyuki
Uemura, Shiro
Saito, Yoshihiko
author_sort Ueda, Tomoya
collection PubMed
description BACKGROUND: Renal impairment is a common comorbidity and the strongest risk factor for poor prognosis in acute decompensated heart failure (ADHF). In clinical practice, renal function is labile during episodes of ADHF, and often worsens after discharge. The significance of worsening of renal function (WRF) after discharge has not been investigated as extensively as baseline renal function at admission or WRF during hospitalization. METHODS AND RESULTS: Among 611 consecutive patients with ADHF emergently admitted to our hospital, 233 patients with 3 measurements of serum creatinine (SCr) level measurements (on admission, at discharge, and 1 year after discharge) were included in the present study. Patients were divided into 2 groups according to the presence or absence of WRF at 1 year after discharge (1y‐WRF), defined as an absolute increase in SCr >0.3 mg/dL (>26.5 μmol/L) plus a ≥25% increase in SCr at 1 year after discharge compared to the SCr value at discharge. All‐cause and cardiovascular mortality were assessed as adverse outcomes. During a mean follow‐up of 35.4 months, 1y‐WRF occurred in 48 of 233 patients. There were 66 deaths from all causes. All‐cause and cardiovascular mortality were significantly higher in patients with 1y‐WRF (log‐rank P<0.0001 and P<0.0001, respectively) according to Kaplan–Meier analysis. In a multivariate Cox proportional hazards model, 1y‐WRF was a strong and independent predictor of all‐cause and cardiovascular mortality. Hemoglobin and B‐type natriuretic peptide at discharge, as well as left ventricular ejection fraction <50%, were independent predictors of 1y‐WRF. CONCLUSIONS: In patients with ADHF, 1y‐WRF is a strong predictor of all‐cause and cardiovascular mortality.
format Online
Article
Text
id pubmed-4338704
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Blackwell Publishing Ltd
record_format MEDLINE/PubMed
spelling pubmed-43387042015-02-27 Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All‐Cause Mortality in Acute Decompensated Heart Failure Ueda, Tomoya Kawakami, Rika Sugawara, Yu Okada, Sadanori Nishida, Taku Onoue, Kenji Soeda, Tsunenari Okayama, Satoshi Takeda, Yukiji Watanabe, Makoto Kawata, Hiroyuki Uemura, Shiro Saito, Yoshihiko J Am Heart Assoc Original Research BACKGROUND: Renal impairment is a common comorbidity and the strongest risk factor for poor prognosis in acute decompensated heart failure (ADHF). In clinical practice, renal function is labile during episodes of ADHF, and often worsens after discharge. The significance of worsening of renal function (WRF) after discharge has not been investigated as extensively as baseline renal function at admission or WRF during hospitalization. METHODS AND RESULTS: Among 611 consecutive patients with ADHF emergently admitted to our hospital, 233 patients with 3 measurements of serum creatinine (SCr) level measurements (on admission, at discharge, and 1 year after discharge) were included in the present study. Patients were divided into 2 groups according to the presence or absence of WRF at 1 year after discharge (1y‐WRF), defined as an absolute increase in SCr >0.3 mg/dL (>26.5 μmol/L) plus a ≥25% increase in SCr at 1 year after discharge compared to the SCr value at discharge. All‐cause and cardiovascular mortality were assessed as adverse outcomes. During a mean follow‐up of 35.4 months, 1y‐WRF occurred in 48 of 233 patients. There were 66 deaths from all causes. All‐cause and cardiovascular mortality were significantly higher in patients with 1y‐WRF (log‐rank P<0.0001 and P<0.0001, respectively) according to Kaplan–Meier analysis. In a multivariate Cox proportional hazards model, 1y‐WRF was a strong and independent predictor of all‐cause and cardiovascular mortality. Hemoglobin and B‐type natriuretic peptide at discharge, as well as left ventricular ejection fraction <50%, were independent predictors of 1y‐WRF. CONCLUSIONS: In patients with ADHF, 1y‐WRF is a strong predictor of all‐cause and cardiovascular mortality. Blackwell Publishing Ltd 2014-11-04 /pmc/articles/PMC4338704/ /pubmed/25370599 http://dx.doi.org/10.1161/JAHA.114.001174 Text en © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/3.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Ueda, Tomoya
Kawakami, Rika
Sugawara, Yu
Okada, Sadanori
Nishida, Taku
Onoue, Kenji
Soeda, Tsunenari
Okayama, Satoshi
Takeda, Yukiji
Watanabe, Makoto
Kawata, Hiroyuki
Uemura, Shiro
Saito, Yoshihiko
Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All‐Cause Mortality in Acute Decompensated Heart Failure
title Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All‐Cause Mortality in Acute Decompensated Heart Failure
title_full Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All‐Cause Mortality in Acute Decompensated Heart Failure
title_fullStr Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All‐Cause Mortality in Acute Decompensated Heart Failure
title_full_unstemmed Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All‐Cause Mortality in Acute Decompensated Heart Failure
title_short Worsening of Renal Function During 1 Year After Hospital Discharge Is a Strong and Independent Predictor of All‐Cause Mortality in Acute Decompensated Heart Failure
title_sort worsening of renal function during 1 year after hospital discharge is a strong and independent predictor of all‐cause mortality in acute decompensated heart failure
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338704/
https://www.ncbi.nlm.nih.gov/pubmed/25370599
http://dx.doi.org/10.1161/JAHA.114.001174
work_keys_str_mv AT uedatomoya worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT kawakamirika worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT sugawarayu worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT okadasadanori worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT nishidataku worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT onouekenji worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT soedatsunenari worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT okayamasatoshi worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT takedayukiji worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT watanabemakoto worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT kawatahiroyuki worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT uemurashiro worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure
AT saitoyoshihiko worseningofrenalfunctionduring1yearafterhospitaldischargeisastrongandindependentpredictorofallcausemortalityinacutedecompensatedheartfailure