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. PLoS One 2017;12(8):e0181373
Date
08/10/2017Pubmed ID
28793319Pubmed Central ID
PMC5549913DOI
10.1371/journal.pone.0181373Scopus ID
2-s2.0-85030615703 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
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/1.73m2) and 37.4% and 26.6% with severely reduced eGFR (<30 ml/min/1.73m2), respectively. Lower eGFR (regardless of last or worst eGFR), particularly eGFR <30 ml/min/1.73m2, 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/1.73m2 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/1.73m2) 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.
Author List
Matsushita K, Kwak L, Hyun N, Bessel M, Agarwal SK, Loehr LR, Ni H, Chang PP, Coresh J, Wruck LM, Rosamond WMESH terms used to index this publication - Major topics in bold
AgedAtherosclerosis
Blood Urea Nitrogen
Cost of Illness
Creatinine
Female
Glomerular Filtration Rate
Heart Failure
Humans
Kidney
Kidney Diseases
Kidney Function Tests
Male
Prognosis
Public Health Surveillance
Risk Assessment
Risk Factors
