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Related Experiment Videos

Kidney function and mortality among patients with left ventricular systolic dysfunction.

Nadia A Khan1, Irene Ma, Christopher R Thompson

  • 1Division of Internal Medicine, University of British Columbia, Department of Medicine, 620-B, 1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6. nakhan@shaw.ca

Journal of the American Society of Nephrology : JASN
|November 18, 2005
PubMed
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Kidney dysfunction and its decline significantly increase mortality risk in heart failure patients. Even mild kidney impairment or rapid eGFR decline predicts higher mortality, independent of heart failure severity.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Epidemiology

Background:

  • Kidney disease is a significant risk factor for mortality in heart failure (HF) populations.
  • Understanding the impact of kidney dysfunction stages and changes on HF mortality is crucial for patient management.

Purpose of the Study:

  • To determine the impact of different stages of kidney dysfunction, classified by the Kidney Disease Outcomes Quality Initiative (K/DOQI), on mortality in HF patients.
  • To assess how changes in kidney function over time affect mortality in this cohort.

Main Methods:

  • Retrospective analysis of 6640 participants from the Studies of Left Ventricular Dysfunction (SOLVD) trials.
  • Estimated glomerular filtration rate (eGFR) calculated and categorized using K/DOQI stages (> or =90, 60-89, 30-59, 15-29 ml/min/1.73 m2).

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  • Rate of eGFR decline calculated and categorized (<5, 5-10, 11-15, >15 ml/min/1.73 m2/year).

    • Main Results:

    • Lower eGFR levels were independently associated with higher total mortality compared to eGFR > or =90 ml/min.
    • Patients with eGFR 30-59 ml/min/1.73 m2 had a 1.32 HR (P=0.004); those with 15-29 ml/min/1.73 m2 had a 2.54 HR (P<0.001).
    • Rapid eGFR decline (>15 ml/min/1.73 m2/year) in 12% of participants significantly increased mortality (HR 5.63, P<0.0001) versus slower decline, independent of HF status.

    Conclusions:

    • K/DOQI eGFR categories are associated with mortality in HF patients.
    • The rate of eGFR decline is a strong, independent predictor of increased mortality in heart failure.
    • Monitoring kidney function and its changes is vital for risk stratification and management in heart failure.