The Paramount Importance of Renal Dysfunction in Heart Failure Prognosis - Results from the REFERENCE study

Abstract

Abstract
Aims
In heart failure patients renal dysfunction represents impaired tissue perfusion.
We investigated the association of customarily used renal function parameters with short-term prognosis in patients admitted with acute decompensated heart failure in class III or IV of New York Heart Association.
Material and Methods
Univariate Cox proportional hazard model was used to assess the relationship between variables and outcomes.
Survival curves were designed using the Kaplan-Meier method.
Results
We followed 65 patients for a median of 13.7 (Q1-Q3 6.7-18.9) months.
Variables associated with an increased risk for short-term rehospitalization were baseline urea (HR: 1.098, 95% CI: 1.022-1.179, P-value=0.01), admission urea (HR: 1.048, 95% CI: 1.013-1.084, P-value=0.006), baseline creatinine (HR: 1.111, 95% CI: 1.004-1.229, P-value=0.041), admission creatinine (HR: 1.047, 95% CI: 1.005-1.092, P-value=0.027) and admission glomerular filtration rate <30 mL/min (HR: 3.535, 95% CI: 1.467-8.518, P-value=0.005).
Increased risk for short-term mortality was associated with baseline urea (HR: 1.145, 95% CI: 1.032-1.270, P-value=0.010), admission urea (HR: 1.076, 95% CI: 1.021-1.135, P-value=0.006), baseline creatinine (HR: 1.157, 95% CI: 1.009-1.328, P value=0.037), admission creatinine (HR: 1.127, 95% CI: 1.055-1.204, P-value<0.001) and admission glomerular filtration rate <30 mL/min (HR: 9.791, 95% CI: 2.855-33.580, P-value<0.001).
Variables associated with an increased risk for end of follow-up mortality were admission urea (HR: 1.056, 95% CI: 1.019-1.094, P-value=0.003), admission creatinine (HR: 1.104, 95% CI: 1.054-1.156, P- value<0.001) and admission glomerular filtration rate <30 mL/min (HR: 3.906, 95% CI: 1.7208.871, P- value=0.001).
Conclusion
Renal dysfunction was a reliable predictor of worse prognosis as several parameters correlated with short-term prognosis.

Resumen
Introducción
En la insuficiencia cardíaca, la disfunción renal representa hipoperfusión tejidual.
Investigamos la asociación entre parámetros utilizados en el cotidiano y el pronóstico precoz de enfermos ingresados por insuficiencia cardíaca descompensada en classe III o IV de New York Heart Association.
Material y métodos
Aplicamos el modelo de riesgo proporcional de Univariante Cox y curvas de supervivencia de Kaplan-Meier.

Resultados
La mediana de seguimiento de los 65 enfermos fue de 13.7 (Q1-Q3 6.7-18.9) meses.
Se correlacionarón con el reingreso precoz la urea basal (HR: 1.098, 95% CI: 1.022-1.179, P-value=0.01), urea al ingreso (HR: 1.048, 95% CI: 1.013-1.084, P-value=0.006), creatinina basal (HR: 1.111, 95% CI: 1.004-1.229, P-value=0.041), creatinina al ingreso (HR: 1.047, 95% CI: 1.005-1.092, P-value=0.027) y tasa de filtración glomerular <30 mL/min al ingreso <30 mL/min (HR: 3.535, 95% CI: 1.467-8.518, P-value=0.005).
El riesgo de mortalidad precoz se correlacionó con la urea basal (HR: 1.145, 95% CI: 1.032-1.270, P-value=0.010), urea al ingreso (HR: 1.076, 95% CI: 1.021-1.135, P-value=0.006), creatinina basal (HR: 1.157, 95% CI: 1.009-1.328, P value=0.037), creatinina al ingreso (HR: 1.127, 95% CI: 1.055-1.204, P-value<0.001) y tasa de filtración glomerular <30 mL/min al ingreso <30 mL/min (HR: 9.791, 95% CI: 2.855-33.580, P-value<0.001).
Se correlacionarón con la mortalidad al final del seguimento la urea al ingreso (HR: 1.056, 95% CI: 1.019-1.094, P-value=0.003), creatinina al ingreso (HR: 1.104, 95% CI: 1.054-1.156, P- value<0.001) y tasa de filtración glomerular <30 mL/min al ingreso (HR: 3.906, 95% CI: 1.7208.871, P- value=0.001).
Conclusiones
La disfunción renal fue un predictor de peor pronóstico precoz.

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