Journal of Cardiac Failure
Volume 13, Issue 6 , Pages 422-430, August 2007

High Prevalence of Renal Dysfunction and Its Impact on Outcome in 118,465 Patients Hospitalized With Acute Decompensated Heart Failure: A Report From the ADHERE Database

  • J. Thomas Heywood, MD, FACC

      Affiliations

    • From the Scripps Clinic, La Jolla, California
    • Corresponding Author InformationReprint requests: J. Thomas Heywood, MD, Director Heart Failure Program, Scripps Clinic, 10666 N. Torrey Pines Road, SW 206, La Jolla, CA 92037.
    • ,
  • Gregg C. Fonarow, MD, FACC

      Affiliations

    • University of California Los Angeles, Los Angeles, California
    • ,
  • Maria Rosa Costanzo, MD, FACC

      Affiliations

    • Midwest Heart Specialists, Naperville, Illinois
    • ,
  • Vandana S. Mathur, MD

      Affiliations

    • MathurConsulting, Woodside, California
    • ,
  • John R. Wigneswaran, MD

      Affiliations

    • Scios Inc., Fremont, California
    • ,
  • Janet Wynne, MS

      Affiliations

    • Scios Inc., Fremont, California
    • ,
  • for the ADHERE Scientific Advisory Committee and Investigators

Received 11 January 2007; received in revised form 14 March 2007; accepted 23 March 2007.

La Jolla, Los Angeles, Woodside, and Fremont, California; Naperville, Illinois

Abstract 

Background

The prevalence of renal dysfunction in patients hospitalized with acute decompensated heart failure remains poorly characterized.

Methods and Results

Data from 118,465 hospitalization episodes were evaluated. Glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease formula. At admission, 10,660 patients (9.0%) had normal renal function (GFR ≥ 90 mL·min·1.73 m2), 32,423 patients (27.4%) had mild renal dysfunction (GFR 60–89 mL·min·1.73 m2), 51,553 patients (43.5%) had moderate renal dysfunction (GFR 30–59 mL·min·1.73 m2), 15,553 patients (13.1%) had severe renal dysfunction (GFR 15–29 mL·min·1.73 m2), and 8276 patients (7.0%) had kidney failure (GFR < 15 mL·min·1.73 m2 or chronic dialysis). Despite this, only 33.4% of men and 27.3% of women were diagnosed with renal insufficiency. Diuretic dose, inotrope use, and nesiritide use increased, whereas angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use decreased, with increasing renal dysfunction (all P < .0001 across stages). In-hospital mortality increased from 1.9% for patients with normal renal function to 7.6% and 6.5% for patients with severe dysfunction and kidney failure, respectively (P < .0001).

Conclusions

The majority of patients admitted with acute decompensated heart failure have significant renal impairment, which influences treatment and outcomes.

Key Words: Heart failure, Renal insufficiency, Registries, Risk assessment

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 The ADHERE database and this study were sponsored by Scios Inc., Fremont, California.Conflicts of Interest Disclosure: J. Thomas Heywood, MD, has a consultant/or advisory board relationship with GlaxoSmithKline, Medtronic, Inc., and Scios Inc. He is on the speaker's bureaus for and has received honoraria from GlaxoSmithKline, Guidant Corporation, Medtronic, Inc., Pfizer Inc., and Scios Inc. He has received research grant support from GlaxoSmithKline; Medtronic, Inc.; Sanofi-Aventis; Scios Inc.; and St. Jude Medical.Gregg C. Fonarow, MD, has a consultant/or advisory board relationship with Scios Inc.'s Steering Committee for the ADHERE Core, EM, and Longitudinal Registries. He is on the speaker's bureau for and has received honoraria from Scios Inc. He has received research grant support from Scios Inc.'s ADHERE Registries and CHF Solutions, Inc.'s UNLOAD Trial.Maria Rosa Costanzo, MD, has a consultant/or advisory board relationship with CHF Solutions, Inc. and Scios Inc. She has received honoraria from CHF Solutions, Inc. and Medtronic, Inc.Vandana S. Mathur, MD, has a consultant/or advisory board relationship with Acologix, Inc.; Corgentech Inc.; FlowMedica, Inc.; Ingenix; Ortho Biotech; RenaMed Biologics; Scios Inc.; Synecor, LLC; and XenoPort, Inc. She is on the speaker's bureau for Scios Inc. She has received honoraria from GE Healthcare and Scios Inc.John R. Wigneswaran, MD, is a former employee of Scios Inc. Before his employment with Scios Inc., he was on the speaker's bureau for Scios Inc. and received honoraria from Scios Inc. He is aware that at the time of his employment at Scios Inc., Scios Inc. funded this article. He owns stock in Johnson & Johnson.Janet Wynne, MS, is an employee of Scios Inc. She owns stock in Johnson & Johnson. She is aware that Scios, Inc. is the sponsor of the ADHERE database.

PII: S1071-9164(07)00103-0

doi:10.1016/j.cardfail.2007.03.011

Journal of Cardiac Failure
Volume 13, Issue 6 , Pages 422-430, August 2007

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