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The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular
D L Dries1, D V Exner, M J Domanski
1Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Insights
Moderate renal insufficiency significantly increases mortality risk in heart failure patients, primarily due to worsening heart failure progression. Adequate kidney function is crucial for managing heart failure and may be a therapeutic target.
Area of Science:
- Cardiology
- Nephrology
- Clinical Research
Background:
- Elevated intracardiac pressures can cause ventricular dilation and heart failure.
- Renal function is critical for fluid balance and managing intracardiac pressures.
Purpose of the Study:
- To investigate the prognostic impact of moderate renal insufficiency in patients with left ventricular systolic dysfunction.
- To determine if renal function influences heart failure progression and mortality.
Main Methods:
- Retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Trials.
- Moderate renal insufficiency defined as creatinine clearance <60 ml/min using the Cockroft-Gault equation.
Main Results:
- Moderate renal insufficiency was linked to increased all-cause mortality in both SOLVD Prevention and Treatment trials (RR 1.41, p=0.001).
- This increased risk was mainly driven by pump-failure deaths and combined endpoints of death or heart failure hospitalization.
Conclusions:
- Moderate renal insufficiency is an independent predictor of mortality in heart failure patients.
- Renal function adequacy appears to be a key factor in heart failure compensation, not just a disease severity marker.
- Therapies improving renal function may potentially slow heart failure progression.
Objectives:
The present analysis examines the prognostic implications of moderate renal insufficiency in patients with asymptomatic and symptomatic left ventricular systolic dysfunction.
Background:
Chronic elevations in intracardiac filling pressures may lead to progressive ventricular dilation and heart failure progression. The ability to maintain fluid balance and prevent increased intracardiac filling pressures is critically dependent on the adequacy of renal function.
Methods:
This is a retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Trials, in which moderate renal insufficiency is defined as a baseline creatinine clearance <60 ml/min, as estimated from the Cockroft-Gault equation.
Results:
In the SOLVD Prevention Trial, multivariate analyses demonstrated moderate renal insufficiency to be associated with an increased risk for all-cause mortality (Relative Risk [RR] 1.41; p = 0.001), largely explained by an increased risk for pump-failure death (RR 1.68; p = 0.007) and the combined end point death or hospitalization for heart failure (RR 1.33; p = 0.001). Likewise, in the Treatment Trial, multivariate analyses demonstrated moderate renal insufficiency to be associated with an increased risk for all-cause mortality (RR 1.41; p = 0.001), also largely explained by an increased risk for pump-failure death (RR 1.49; p = 0.007) and the combined end point death or hospitalization for heart failure (RR 1.45; p = 0.001).
Conclusions:
Even moderate degrees of renal insufficiency are independently associated with an increased risk for all-cause mortality in patients with heart failure, largely explained by an increased risk of heart failure progression. These data suggest that, rather than simply being a marker of the severity of underlying disease, the adequacy of renal function may be a primary determinant of compensation in patients with heart failure, and therapy capable of improving renal function may delay disease progression.