Renal Function in Outpatients With Chronic Heart Failure

Waldum, Bård; Westheim, Arne S.; Sandvik, Leiv; Flønæs, Berit; Grundtvig, Morten; Gullestad, Lars; Hole, Torstein; Os, Ingrid

doi:10.1016/j.cardfail.2010.01.001

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 5 , Pages 374-380, May 2010

Renal Function in Outpatients With Chronic Heart Failure

Bård Waldum, MD
- Department of Nephrology, Ullevål University Hospital, Oslo, Norway
- Reprint requests: Bård Waldum, MD, Department of Nephrology, Ullevål University Hospital, N-0407 Oslo, Norway. Tel: +47 22 11 91 00; Fax: +47 23 01 59 50.
Arne S. Westheim, MD, PhD
- Department of Cardiology, Ullevål University Hospital, Oslo, Norway
Leiv Sandvik, PhD
- Department of Biostatistics, Ullevål University Hospital, Oslo, Norway
Berit Flønæs, RN
- Department of Medicine, Asker and Bærum Health Authority, Sandvika, Norway
Morten Grundtvig, MD
- Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway
Lars Gullestad, MD, PhD
- Department of Cardiology, Rikshospitalet University Clinic, Oslo, Norway
Torstein Hole, MD, PhD
- Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine, Ålesund Hospital, Helse Sunnmøre HF, Ålesund, Norway
Ingrid Os, MD, PhD
- Department of Nephrology, Ullevål University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway

Received 8 January 2009; received in revised form 4 January 2010; accepted 12 January 2010. published online 04 March 2010.

Abstract

Background

Impaired renal function confers an adverse prognosis in patients with heart failure (HF). The aims of the present study were to identify factors associated with and predictive of impaired renal function and to assess the relationship between estimated glomerular filtration rate (eGFR) and all-cause mortality in outpatients with HF.

Methods and Results

Baseline data on 3605 patients (median age 73 years, 70.1% men) from 24 outpatient HF clinics in Norway were analyzed. Median follow-up time was 9 months. Renal dysfunction (eGFR < 60 mL/min) was present in 44.9%. The population was randomized into equal-sized model-building and validation samples to enhance model stability. eGFR was an independent predictor of all-cause mortality (HR 0.94 per 5 mL/min increase, P = .001). Use of spironolactone (P = .002), higher blood pressure (P < .001), and lower hemoglobin levels (P = .002) were predictors of impaired renal function. Increasing doses of loop diuretics were strongly associated with eGFR at baseline (P < .001), but only tended to predict worsening renal function during follow-up (P = .08).

Conclusions

Clinically significant reduction in renal function was prevalent in outpatients with HF, and was a strong predictor of all-cause mortality. Use of loop diuretics and spironolactone should be carefully evaluated as these agents may adversely affect renal function.

Key Words: Kidney function, diuretics, mortality, predictors