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Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance

BACKGROUND: Kidney dysfunction is prevalent and impacts prognosis in patients with acute decompensated heart failure (ADHF). However, most previous reports were from a single hospital, limiting their generalizability. Also, contemporary data using new equation for estimated glomerular filtration rat...

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Autores principales: Matsushita, Kunihiro, Kwak, Lucia, Hyun, Noorie, Bessel, Marina, Agarwal, Sunil K., Loehr, Laura R., Ni, Hanyu, Chang, Patricia P., Coresh, Josef, Wruck, Lisa M., Rosamond, Wayne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549913/
https://www.ncbi.nlm.nih.gov/pubmed/28793319
http://dx.doi.org/10.1371/journal.pone.0181373
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author Matsushita, Kunihiro
Kwak, Lucia
Hyun, Noorie
Bessel, Marina
Agarwal, Sunil K.
Loehr, Laura R.
Ni, Hanyu
Chang, Patricia P.
Coresh, Josef
Wruck, Lisa M.
Rosamond, Wayne
author_facet Matsushita, Kunihiro
Kwak, Lucia
Hyun, Noorie
Bessel, Marina
Agarwal, Sunil K.
Loehr, Laura R.
Ni, Hanyu
Chang, Patricia P.
Coresh, Josef
Wruck, Lisa M.
Rosamond, Wayne
author_sort Matsushita, Kunihiro
collection PubMed
description BACKGROUND: Kidney dysfunction is prevalent and impacts prognosis in patients with acute decompensated heart failure (ADHF). However, most previous reports were from a single hospital, limiting their generalizability. Also, contemporary data using new equation for estimated glomerular filtration rate (eGFR) are needed. METHODS AND RESULTS: We analyzed data from the ARIC Community Surveillance for ADHF conducted for residents aged ≥55 years in four US communities between 2005–2011. All ADHF cases (n = 5, 391) were adjudicated and weighted to represent those communities (24,932 weighted cases). The association of kidney function (creatinine-based eGFR by the CKD-EPI equation and blood urea nitrogen [BUN]) during hospitalization with 1-year mortality was assessed using logistic regression. Based on worst and last serum creatinine, there were 82.5% and 70.6% with reduced eGFR (<60 ml/min/1.73m(2)) and 37.4% and 26.6% with severely reduced eGFR (<30 ml/min/1.73m(2)), respectively. Lower eGFR (regardless of last or worst eGFR), particularly eGFR <30 ml/min/1.73m(2), was significantly associated with higher 1-year mortality independently of potential confounders (odds ratio 1.60 [95% CI 1.26–2.04] for last eGFR 15–29 ml/min/1.73m(2) and 2.30 [1.76–3.00] for <15 compared to eGFR ≥60). The association was largely consistent across demographic subgroups. Of interest, when both eGFR and BUN were modeled together, only BUN remained significant. CONCLUSIONS: Severely reduced eGFR (<30 ml/min/1.73m(2)) was observed in ~30% of ADHF cases and was an independent predictor of 1-year mortality in community. For prediction, BUN appeared to be superior to eGFR. These findings suggest the need of close attention to kidney dysfunction among ADHF patients.
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spelling pubmed-55499132017-08-15 Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance Matsushita, Kunihiro Kwak, Lucia Hyun, Noorie Bessel, Marina Agarwal, Sunil K. Loehr, Laura R. Ni, Hanyu Chang, Patricia P. Coresh, Josef Wruck, Lisa M. Rosamond, Wayne PLoS One Research Article BACKGROUND: Kidney dysfunction is prevalent and impacts prognosis in patients with acute decompensated heart failure (ADHF). However, most previous reports were from a single hospital, limiting their generalizability. Also, contemporary data using new equation for estimated glomerular filtration rate (eGFR) are needed. METHODS AND RESULTS: We analyzed data from the ARIC Community Surveillance for ADHF conducted for residents aged ≥55 years in four US communities between 2005–2011. All ADHF cases (n = 5, 391) were adjudicated and weighted to represent those communities (24,932 weighted cases). The association of kidney function (creatinine-based eGFR by the CKD-EPI equation and blood urea nitrogen [BUN]) during hospitalization with 1-year mortality was assessed using logistic regression. Based on worst and last serum creatinine, there were 82.5% and 70.6% with reduced eGFR (<60 ml/min/1.73m(2)) and 37.4% and 26.6% with severely reduced eGFR (<30 ml/min/1.73m(2)), respectively. Lower eGFR (regardless of last or worst eGFR), particularly eGFR <30 ml/min/1.73m(2), was significantly associated with higher 1-year mortality independently of potential confounders (odds ratio 1.60 [95% CI 1.26–2.04] for last eGFR 15–29 ml/min/1.73m(2) and 2.30 [1.76–3.00] for <15 compared to eGFR ≥60). The association was largely consistent across demographic subgroups. Of interest, when both eGFR and BUN were modeled together, only BUN remained significant. CONCLUSIONS: Severely reduced eGFR (<30 ml/min/1.73m(2)) was observed in ~30% of ADHF cases and was an independent predictor of 1-year mortality in community. For prediction, BUN appeared to be superior to eGFR. These findings suggest the need of close attention to kidney dysfunction among ADHF patients. Public Library of Science 2017-08-09 /pmc/articles/PMC5549913/ /pubmed/28793319 http://dx.doi.org/10.1371/journal.pone.0181373 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Matsushita, Kunihiro
Kwak, Lucia
Hyun, Noorie
Bessel, Marina
Agarwal, Sunil K.
Loehr, Laura R.
Ni, Hanyu
Chang, Patricia P.
Coresh, Josef
Wruck, Lisa M.
Rosamond, Wayne
Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance
title Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance
title_full Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance
title_fullStr Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance
title_full_unstemmed Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance
title_short Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance
title_sort community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: the atherosclerosis risk in communities (aric) study community surveillance
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549913/
https://www.ncbi.nlm.nih.gov/pubmed/28793319
http://dx.doi.org/10.1371/journal.pone.0181373
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