pproximately one third to one half of patients with heart failure have renal insufficiency, which is one of the strongest predictors of mortality in these patients. However, there is little evidence with which to weigh the risks of cardiac transplantation in heart failure patients who have mild renal dysfunction.
We reviewed the clinical and laboratory data of 140 consecutive, stable heart failure patients who had mild renal insufficiency (serum creatinine, 1.1-2.5) referred to our institution for evaluation for cardiac transplantation from May 2004 to April 2005. We then assessed the association between renal dysfunction and 1-year outcomes (either death from any cause or admission for heart failure). The combined endpoint was compared with various levels of baseline serum creatinine values: mild (1.1-1.5), moderate (1.6-2.0), and severe (2.1-2.5). Of the 140 patients, 98 had follow-up visits where laboratory values were obtained. In this subgroup, logistic regression analysis was performed to the model hazard ratio (HR) to achieve the combined endpoint.
The cohort was predominantly Caucasian (45%) and male (68%). After 1-year, the combined endpoint was met in 43%, 57%, and 42% of patients with mild, moderate, and severe elevations of serum creatinine, respectively. There was no statistical difference between the 3 groups (Kruskal-Wallis One-Way ANOVA p=0.36). However, in the 98 patients who had follow-up laboratory testing during the study period, a dynamic change in serum creatinine levels was strongly associated with a combined outcome (HR, 1.70; 95%CI, 1.22-24.6; P=0.02). This association remained significant even after adjustment for other clinical variables, including patient age and baseline serum creatinine levels (HR, 1.71; 95%CI, 1.18-26.1; P=0.02).
A dynamic change in serum creatinine values during follow-up is a strong independent predictor of a worse prognosis for heart failure patients.
These findings suggest that monitoring of serum creatinine values may offer a readily accessible tool to identify which heart failure patients would or would not benefit from cardiac transplantation. A prospective, randomized trial to test this hypothesis is warranted.
Shun Kohsaka, None.