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Evolution of renal function during and after an episode of cardiac decompensation: results from the Italian survey on acute heart failure

Tarantini, Luigi; Cioffi, Giovanni; Gonzini, Lucio; Oliva, Fabrizio; Lucci, Donata; Di Tano, Giuseppe; Maggioni, Aldo Pietro; Tavazzi, Luigion behalf of the Italian Acute Heart Failure Survey

Journal of Cardiovascular Medicine: April 2010 - Volume 11 - Issue 4 - p 234–243
doi: 10.2459/JCM.0b013e3283334e12
Original articles

Background Renal dysfunction is frequently associated with heart failure and strongly influences the outcome of heart failure patients. Although recommended pharmacological interventions for heart failure may contribute to the development of, or worsen renal dysfunction, their relations with renal function have not been fully explored in an unselected community population.

Methods and aim We studied 1008 patients recruited in the Italian survey on acute heart failure to assess the prevalence, the prognostic role of renal function and the relations between the changes in renal function and the pharmacological interventions during hospitalization and at 6-month follow-up. Patients were categorized using the National Kidney Foundation cut-offs for degree of renal function measured by the glomerular filtration rate.

Results Moderate-to-severe renal dysfunction was diagnosed in 59% of patients at hospital admission and 61% at discharge. These patients were older and had a higher prevalence of diabetes, anemia, history of hypertension, myocardial infarction and hospitalization for heart failure than those with normal or mildy impaired renal function. At admission the former were treated more frequently with diuretics, angiotensin converting enzyme-inhibitor (ACEi) or angiotensin receptor blockers (ARBs) than the latter. Diuretics were given at higher dose and for a longer time during the hospital stay while beta-blockers, digoxin, antialdosterone agents, ACEi and ARBs were given less frequently in patients who had moderate-to-severe renal dysfunction than those who did not. High-dose diuretic treatment, inability to start or maintain beta-blockers during hospital stay and the nonprescription of ACEi/ARBs at discharge emerged, by multivariate analysis, as predictors of death at 6-month follow-up (mortality rate = 14%), independent of the persistence of moderate-to-severe renal dysfunction over time, anemia, male sex and history of heart failure.

Conclusions In acute heart failure, renal dysfunction is frequent and impacts prognosis. In this setting, the pharmacological interventions are significantly associated with changes in renal function and 6-month mortality.

aCardiology Department, St. Martino Hospital, Azienda Sanitaria Locale n°1, Belluno, Italy

bCardiology Department, Villa Bianca Hospital, Trento, Italy

cCentro Studi ANMCO (Associazione Nazionale Cardiologi Ospedalieri), Italy

dCardiologia 2, Insufficienza Cardiaca e Trapianto, Dipartimento Cardiologico 'A. De Gasperis, Azienda Ospedaliera Niguarda Cà Granda, Milan, Italy

eCardiology Unit, Azienda Istituti Ospitalieri, Cremona, Italy

fGVM Hospitals of Care and Research, c/o Villa Maria Cecilia Hospital, Cotignola, (Ravenna), Italy

Received 17 May, 2009

Revised 18 September, 2009

Accepted 22 September, 2009

Correspondence to Dr Luigi Tarantini Ospedale ‘San Martino’, Cardiology Department, ASL n°1, Viale Europa 21, 32100 Belluno, Italy E-mail: gitarant@yahoo.com

© 2010 Italian Federation of Cardiology. All rights reserved.