Takamasa Sato, Hiroyuki Yamauchi, Satoshi Suzuki, Akiomi Yoshihisa, Takayoshi Yamaki, Koichi Sugimoto, Hiroyuki Kunii, Kazuhiko Nakazato, Shu-ichi Saitoh and Yasuchika Takeishi
Background: Impaired renal function is a strong prognostic factor in Chronic Heart Failure (CHF). Most studies ofit, however, have assessed single measurements of renal function. Thus, the purpose of the present study was todetermine the prognostic significance and importance of serial measurements of renal function before and afterhospital discharge.
Methods and results: A total of 542 consecutive patients admitted for worsening CHF (455 males, 60.6 ± 14.2years) were studied. Estimated glomerular filtration rate (eGFR) was evaluated before discharge and 6 months later.Patients were followed-up to register cardiac death and rehospitalization due to worsening heart failure. We dividedstudy subjects into four groups based on changes in renal function between before discharge and 6 months after.These were Group 1: normal to normal eGFR (≥60 mL/min/17.3m2), Group 2: reduced (<60 mL/min/17.3m2) tonormal eGFR, Group 3: normal to reduced eGFR, and Group 4: reduced to reduced eGFR. Compared to Group 1,Groups 2, 3 and 4 had relative risks of 2.265-fold (P<0.05), 4.055-fold (P<0.001) and 3.974-fold (P<0.001),respectively, for adverse cardiac events after discharge. The multivariate Cox proportional hazard regressionanalysis demonstrated that log BNP at 6 months after discharge (hazard ratio [HR]: 1.768, P<0.001), peak VO2 (HR:0.859, P<0.001) and eGFR <60 mL/min/1.73m2 at 6 months (HR: 1.854, P<0.05), but not eGFR at discharge, wereindependent predictors for cardiac events.
Conclusion: Changes in renal function by serial measurements after discharge are important for the assessmentof risk in CHF.
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