Abstract: Poster Presentations |


Jun R. Chiong, MD*; Binu Jacob, MD; Robert F. Percy, MD; Hector P. Sanchez, MD; Anabel C. Castro, MD; Alan B. Miller, MD
Author and Funding Information

University of Florida, Jacksonville, FL


Chest. 2005;128(4_MeetingAbstracts):291S. doi:10.1378/chest.128.4_MeetingAbstracts.291S
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PURPOSE:  Renal function is an underappreciated prognostic factor in heart failure (HF), and renal insufficiency is commonly viewed as a relative contraindication for some proven efficacious therapies. It is unclear whether ACE inhibitors, aldosterone antagonists and beta-blockers exert similar benefits in patients with kidney disease as these patients are infrequently enrolled in HF trials.

METHODS:  We analyzed data from a prospective cohort of heart failure patients followed in a specialty clinic. Renal insufficiency was defined as creatinine clearance <60 mL /min using the Cockcroft-Gault equation. Our hypothesis was that renal insufficiency was an independent predictor of outcome as measured by hospitalizations.

RESULTS:  In our database of 167 outpatients, 71 (42%) had creatinine clearances calculated at > 60 mL/min (Group 1; mean creatinine clearance of 81.6 mL/min); 96 (58%) had creatinine clearances calculated < 60 mL/min (Group 2; mean creatinine clearance of 39.7 mL/min). There was no difference in the presence of co-morbidities including hypertension, diabetes, and hyperlipidemia. Group 2 patients were older (71±17 versus 60±9 years) and had more atrial fibrillation (32% vs. 18%; p=0.043). The log of pro-brain natriuretic peptide (pro-BNP) level was higher in Group 2 (7.6 + 1.5 vs. 6.7 + 1.5; p<0.0001). The two Groups were similar regarding the etiology of heart failure (52% ischemic in Group 1; 57% in Group 2; p=NS), and advanced heart failure NYHA III/IV (61% in Group 1; 62% in Group 2; p=NS). Patients in both groups received identical therapy, except statin therapy (61% in Group 1; 41% in Group 2; p=0.011). All cause hospitalization rate for Group 2 was greater compared to Group 1 patients (1.6 vs. 1.2 admissions per patient; p<0.05).

CONCLUSION:  Despite similarities in therapies, co-morbidities, NYHA functional class and etiology of heart failure, patients with renal dysfunction with systolic heart failure had a greater all cause hospitalization rate than patients with preserved renal function.

CLINICAL IMPLICATIONS:  Abnormal renal function is prevalent in patients with systolic heart failure and is an independent prognostic factor for hospitalization.

DISCLOSURE:  Jun Chiong, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM




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