Original articleClinical characteristics and prognostic influence of renal dysfunction in heart failure patients with preserved ejection fraction
Introduction
Heart failure (HF) is the leading cause of hospital admissions among patients older than 65 years of age, both in Europe and the United States [1], [2]. Despite adequate treatment, HF is a progressive and fatal disorder with high mortality and hospital readmission rates [3].
Heart failure with preserved ejection fraction (HFPEF) accounts for 50% of all patients diagnosed with HF [4], [5]. Its prevalence is even higher in Internal Medicine units [6]. HFPEF especially affects elderly patients and is associated with a number of comorbidities, including impaired renal function, which is associated with a less favorable prognosis [7], [8], [9], [10], [11], [12], [13]. Nevertheless, most studies have only assessed this relationship in patients with systolic dysfunction, whereas there is less scientific information among HFPEF patients. Prior studies have mainly assessed renal function by evaluating either plasma creatinine concentrations, or estimated glomerular filtration rate (eGFR), or blood urea nitrogen (BUN). Each of these have been shown to be useful markers in determining the prognosis of HF [7], [8], [9], [10], [11], [12], [13], [14], [15], however, no prospective studies have evaluated prognostic information yielded by their combination in HFPEF patients.
Our study aimed primarily to assess the impact of renal dysfunction on all-cause mortality in a cohort of patients with HFPEF admitted with acute decompensated HF. Additionally, we sought to evaluate which of the current parameters of estimating renal function had better prognostic performance and to evaluate the rate of renal function decline and the clinical characteristics of patients that deteriorate renal function during the first year of follow-up.
Section snippets
Patient
Patient data were collected from the Spanish National Registry on Heart Failure (RICA), supported by the Spanish Working Group of Heart Failure of the Spanish Society of Internal Medicine, that is a multicenter, prospective, cohort study, whose characteristics have been described elsewhere [16], [17]. This registry includes data from 52 Spanish hospitals. The investigation conformed with the principles outlined in the Declaration of Helsinki. The study protocol was approved by the Ethics
Results
At the time of analysis there were 750 patients included in RICA registry, of whom 455 (62%) had HFPEF. Their baseline characteristics according to renal function at admission are shown in Table 1.
Discussion
Our study draws three main conclusions. Firstly, variable degrees of renal dysfunction are frequent among patients admitted in hospital with acute decompensated HFPEF. Secondly, renal impairment in such patients is independently associated with an increase in mortality during follow-up; and finally we observed that the decline in renal function happens in almost 17% of patients and is associated with diabetes mellitus and the use of MRA.
The relationship between renal function and outcome in HF
Learning points
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A significant degree of renal dysfunction is common among HFPEF patients.
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Impaired renal function is correlated with higher mortality rate.
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Decline in renal function during the first year of follow-up after admission for heart failure is associated with diabetes and MRA prescriptions.
Conflict of interest
The authors declare not to have any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, the work entitled “Clinical Characteristics and Prognostic influence of Renal Dysfunction in Heart Failure Patients with Preserved Ejection Fraction.” and submitted for revision to European Journal of Internal
Acknowledgments
We gratefully acknowledge all investigators who form part of the RICA Registry. We also acknowledge Dra. Elena Rivero Sanz for her contribution to the English translation of the manuscript. We would like to thank RICA's Registry Coordinating Center “S&H Medical Science Service” for their monitoring, logistics support, and administrative work. This work was supported by an educational unrestricted scholarship granted by Laboratorios Menarini.
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The RICA Investigators are listed in the Appendix.