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Impaired renal function affects clinical outcomes and management of patients with heart failure
AIMS: Inpatients 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 RESULTS: Admissions between 1/4/2013 and 30/4/2015 diagnos...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695174/ https://www.ncbi.nlm.nih.gov/pubmed/28872780 http://dx.doi.org/10.1002/ehf2.12185 |
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author | Jenkins, Rebeka Mandarano, Lilly Gugathas, Saraniga Kaski, Juan Carlos Anderson, Lisa Banerjee, Debasish |
author_facet | Jenkins, Rebeka Mandarano, Lilly Gugathas, Saraniga Kaski, Juan Carlos Anderson, Lisa Banerjee, Debasish |
author_sort | Jenkins, Rebeka |
collection | PubMed |
description | AIMS: Inpatients 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 RESULTS: Admissions 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. CONCLUSIONS: Inpatients with heart failure and renal impairment, acute and chronic, failed to receive recommended therapy and had poor outcomes. |
format | Online Article Text |
id | pubmed-5695174 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-56951742018-02-14 Impaired renal function affects clinical outcomes and management of patients with heart failure Jenkins, Rebeka Mandarano, Lilly Gugathas, Saraniga Kaski, Juan Carlos Anderson, Lisa Banerjee, Debasish ESC Heart Fail Original Research Articles AIMS: Inpatients 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 RESULTS: Admissions 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. CONCLUSIONS: Inpatients with heart failure and renal impairment, acute and chronic, failed to receive recommended therapy and had poor outcomes. John Wiley and Sons Inc. 2017-09-05 /pmc/articles/PMC5695174/ /pubmed/28872780 http://dx.doi.org/10.1002/ehf2.12185 Text en © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Articles Jenkins, Rebeka Mandarano, Lilly Gugathas, Saraniga Kaski, Juan Carlos Anderson, Lisa Banerjee, Debasish Impaired renal function affects clinical outcomes and management of patients with heart failure |
title | Impaired renal function affects clinical outcomes and management of patients with heart failure |
title_full | Impaired renal function affects clinical outcomes and management of patients with heart failure |
title_fullStr | Impaired renal function affects clinical outcomes and management of patients with heart failure |
title_full_unstemmed | Impaired renal function affects clinical outcomes and management of patients with heart failure |
title_short | Impaired renal function affects clinical outcomes and management of patients with heart failure |
title_sort | impaired renal function affects clinical outcomes and management of patients with heart failure |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695174/ https://www.ncbi.nlm.nih.gov/pubmed/28872780 http://dx.doi.org/10.1002/ehf2.12185 |
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