Renal function in chronic heart failure : a cohort study

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Renal dysfunction is strongly associated with adverse health outcomes in chronic heart failure. The term cardio-renal syndrome has been proposed to describe the theoretical models developed to explain the pathophysiological mechanisms underpinning the condition and many observational studies undertaken to characterise and identify risk factors and morbidity and mortality outcomes. There is evidence baseline glomerular filtration rate is a stronger predictor of mortality in patients with Heart Failure than left ventricular ejection fraction or NYHA functional class. However, the ambiguity surrounding definitions and nomenclature for renal dysfunction in heart failure has impeded progress for a clearly defined risk profile and characterization for heart failure patients with renal impairment, chronic kidney disease, worsening renal function, or acute kidney injury. The focus of this study was to characterize an Australian cohort of hospitalised heart failure patient who developed acute kidney injury, and investigate this relationship in terms of morbidity and mortality at 12-months follow-up. A secondary purpose was to determine the prevalence of confirmed chronic kidney disease and renal impairment in the cohort and their outcomes. The results highlight the prevalence of Renal Insufficiency and Chronic Kidney Disease, 59% and 52% respectively. Acute kidney injury occurred in 1 in 4 patients when diagnosed using a modified AKIN definition. Characterization of HF patients with any type of renal abnormality revealed a history of multiple comorbidities where concurrent diabetes exposed hospitalised HF patients to an increased risk of AKI. From an original sample of 265 admissions, 166 had data available for the 12-month follow-up morbidity and survival analysis. The reduced sample size limited the study power, such that only renal impairment was trending towards significance. The Kaplan-Meier survival distributions for acute kidney injury and renal impairment at 12-months follow-up was not statistically significant, log-rank p=0.4714 and p=0.0579 respectively. The findings confirm the high incidence and prevalence of renal dysfunction in hospitalised heart failure patients and demonstrate the utility of the AKIN AKI definition. The study strengthens the call for community monitoring of renal function and the need for definitional and nomenclature consensus. A move towards improved monitoring and a standardised taxonomy would assist with differentiating renal dysfunction types and may lead to better risk stratification of HF patients for adverse events.
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