Worsening renal function in patients with acute decompensated heart failure treated with ultrafiltration: predictors and outcomes. J Card Fail 2013 Dec;19(12):787-94
Date
11/13/2013Pubmed ID
24216101DOI
10.1016/j.cardfail.2013.10.011Scopus ID
2-s2.0-84890304473 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
BACKGROUND: Ultrafiltration (UF) is used to treat patients with diuretic-resistant acute decompensated heart failure. The aim of this study was to identify predictors and the effect of worsening renal failure (WRF) on mortality in patients treated with UF.
METHODS AND RESULTS: Based on changes in serum creatinine, 99 patients treated with UF were divided into WRF and control groups. Overall creatinine increased from 1.9 ± 9.7 to 2.2 ± 2.0 mg/dL (P < .001), and WRF developed in 41% of the subjects. The peak UF rate was higher in the WRF group in univariate analysis (174 ± 45 vs 144 ± 42 mL/h; P = .03). Based on multivariate analysis, aldosterone antagonist treatment (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.17-13.46, P = .04), heart rate ≤65 beats/min (OR 6.03, 95% CI 1.48-48.42; P = .03), and E/E' ≥15 (OR 3.78, 95% CI 1.26-17.55; P = .04) at hospital admission were associated with WRF. Patients with baseline glomerular filtration rate (GFR) ≤60 mg/dL who developed WRF during UF had a 75% 1-year mortality rate.
CONCLUSIONS: WRF occurred frequently during UF. Increased LV filling pressures, lower heart rate, and treatment with aldosterone antagonist at hospital admission can identify patients at increased risk for WRF. Patients with baseline GFR ≤60 mg/dL and WRF during UF have an extremely high 1-year mortality rate.
Author List
Raichlin E, Haglund NA, Dumitru I, Lyden ER, Johnston MD, Mack JM, Windle JR, Lowes BDAuthor
Eugenia Raichlin MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute DiseaseAged
Female
Heart Failure
Heart Rate
Hemofiltration
Hospitalization
Humans
Kidney
Male
Middle Aged
Mortality
Predictive Value of Tests
Renal Insufficiency
Retrospective Studies
Treatment Outcome
Ultrafiltration