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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 PMID: 28793319 PMCID: PMC5549913

Pubmed ID

28793319

DOI

10.1371/journal.pone.0181373

Abstract

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 W

Author

Noorie Hyun PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-85030615703

MESH terms used to index this publication - Major topics in bold

Aged
Atherosclerosis
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
jenkins-FCD Prod-321 98992d628744e349846c2f62ac68f241d7e1ea70