Abstract

Background and Aim: The interaction between heart and kidneys has increased, and parts of the pathophysiological background for the cardiorenal syndrome have been established. This study aimed to determine the prevalence, predictors, and prognostic impact of Renal Dysfunction (RD) among hospitalized patients with systolic Heart Failure (HF). Methods: This cross-sectional study included 1559 patients, who were admitted with a diagnosis of systolic HF during the period from 1-March-2011 till 20-June- 2019 at Madinah cardiac center. RD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. Results: Of the total of 1559 patients, 67.2% were males, 51.3% were hypertensive, 56.1% were diabetic and 49.1% were anemic. 60.9% of patients had RD. HF patients with RD were significantly older (p<0.001), had a history of Hypertension (HTN) (p<0.001), Diabetes Mellitus (DM) (p<0.001), anemia (p<0.001), stroke (p<0.003) and smoking (p<0.001). Multivariate analysis showed that older age (OR, 1.1; 95% CI, 1.05-1.07; p<0.001), history of DM (OR, 1.5; 95% CI, 1.14-1.86; p≤0.003), HTN (OR, 1.4; 95% CI,1.11-1.81; p≤0.005), and anemia (OR, 1.6; 95% CI,1.30-2.06; p<0.001) were the predictors of RD. Patients with RD had a significantly higher death rate and total length stay (p<0.001). However, the hospitalization rate was not significant (p≤0.111). Conclusions: About 60.9% of systolic HF patients had RD. Older age, history of DM, HTN, and anemia were predictors of RD. Patients with RD had a higher death rate and a total length of stay.

Keywords: Renal Dysfunction · Heart Failure · Glomerular Filtration Rate · Cardiorenal Syndrome

References

  1. 1.AlHabeeb W, Al-Ayoubi F, AIGhalayini K, Al Ghofaili F, Al Hebaishi Y, Al-Jazairi A. Saudi Heart Association (SHA) Guidelines for the Management of Heart Failure. J Saudi HearAssoc 2019; 31(4): 204-253.
  2. 2.Sánchez-Torrijos J, Gudín-Uriel M, Nadal-Barangé M, Jacas-Osborn V, Trigo-Bautista A, Giménez-Alcalá M. Prognostic Value of Discharge Hemoglobin Level in Patients Hospitalized for Acute Heart Failure. Rev Esp Cardiol 2006; 59(12): 1276–1282.
  3. 3.Löfman I, Szummer K, Hagerman I, Dahlström U, Lund LH, JernbergT. Prevalence and prognostic impact of kidney dis- Majmaah Journal of Health Sciences ,Vol. 9, Issue 2, April - 2021, Shaban - 1442 33 Prevalence, Predictors and Prognostic Impact of Renal Dysfunction among Hospitalized Patients with Systolic Heart Failure ease on heart failure patients. Open Hear 2016; 3(1): e000324.
  4. 4.Silverberg DS, Wexler D, Blum M, Keren G, Sheps D, Leibovitch E. The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol 2000; 35(7): 1737–1744.
  5. 5.Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J. High Prevalence of Renal Dysfunction and Its Impact on Outcome in 118,465 Patients Hospitalized With Acute Decompensated Heart Failure: A Report From the ADHERE Database. J Card Fail 2007; 13(6): 422–430.
  6. 6.Pai P. Cardiorenal syndrome. Hong Kong J Nephrol 2015; 17(2): 36–45.
  7. 7.Yu HT. Progression of Chronic Renal Failure. Arch Intern Med 2003; 163(12): 1417–1429.
  8. 8.Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P. Renal Impairment and Outcomes in Heart Failure. Systematic Review and Meta-Analysis. J Am Coll Cardiol 2006; 47(10): 1987–1996.
  9. 9.Ärnlöv J. Diminished renal function and the incidence of heart failure. Curr Cardiol Rev 2009; 5(3): 223–227.
  10. 10.Valente MAE, Hillege HL, Navis G, Voors AA, Dunselman PHJM, Van Veldhuisen DJ. The Chronic Kidney Disease Epidemiology Collaboration equation outperforms the modification of Diet in Renal Diseaseequationforestimatingglomerular filtration rate in chronic systolic heart failure. Eur J Heart Fail 2014; 16(1):86–94. 11.MyersGL,MillerWG,CoreshJ,Fleming J, Greenberg N, Greene T. Recommendations for improving serum creatinine measurement:Areport from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 2006; 52(1): 5–18.
  11. 11.World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Miner Nutr Inf Syst World Heal Organ 2013;1–6. 13.WorldMedicalAssociationDeclaration ofHelsinki.JAMA2013;310(20):2191.
  12. 12.Ahmed A, Campbell RC et.al. Epidemiology of Chronic Kidney Disease in Heart Failure. Heart Fail Clin 2008; 4(4):387–399.
  13. 13.Liu PP. Cardiorenal syndrome in heart failure: A cardiologist’s perspective. Can J Cardiol 2011; 24(7):25-29.
  14. 14.Ronco C, Di Lullo L. Cardiorenal Syndrome in Western Countries: Epidemiolo- 34 Majmaah Journal of Health Sciences ,Vol. 9, Issue 2, April - 2021, Shaban - 1442 Prevalence, Predictors and Prognostic Impact of Renal Dysfunction among Hospitalized Patients with Systolic Heart Failure gy, Diagnosis and ManagementApproaches. Kidney Dis 2016; 2(4):151–163.
  15. 15.Baydemir C, Ural D, Karaüzüm K, Balci S, Argan O, Karaüzüm I. Predictors of Long-Term Mortality and Frequent Re-Hospitalization in Patients with Acute Decompensated Heart Failure and Kidney Dysfunction Treated with Renin-Angiotensin System Blockers. Med Sci Monit 2017;23:3335–3344.
  16. 16.Sarnak M.APatient with Heart Failure and Worsening Kidney Function. Clinical Journal of the American Society of Nephrology 2014; 9(10):1790-1798.
  17. 17.Hebert K, Dias A, Delgado MC, Franco E, Tamariz L, Steen D. Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population. Eur J Heart Fail 2010; 12(8):861–865.
  18. 18.Verdiani V, Lastrucci V, Nozzoli C. Worsening Renal Function in Patients Hospitalized with Acute Heart Failure: Risk Factors and Prognostic Significances. Int J Nephrol 2010; 2011:1–5.
  19. 19.Kottgen A, Russell SD, Loehr LR, Crainiceanu CM, Rosamond WD, Chang PP. Reduced Kidney Function as a Risk Factor for Incident Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study. J Am Soc Nephrol 2007; 18(4):1307–1315.
  20. 20.Fox CS, Larson MG, Leip EP, Culleton B, Wilson PWF, Levy D. Predictors of New-Onset Kidney Disease in a Community-Based Population. J Am Med Assoc 2004; 291(7):844–850.
  21. 21.Matsushita K, Kwak L, Hyun N, Bessel M, Agarwal SK, Loehr LR. Community burden and prognostic impact of reduced kidney function among patients hospitalized with acute decompensated heart failure: The Atherosclerosis Risk in Communities (ARIC) Study Community Surveillance. PLoS One 2017; 12(8).
  22. 22.Alsuwaida AO, Farag YMK, Al SayyariAA, Mousa D,Alhejaili F,Al-HarbiA. Epidemiology of chronic kidney disease in the Kingdom of SaudiArabia (SEEK-Saudi investigators) - a pilot study. Saudi J Kidney Dis Transplant 2010; 21(6): 1066– 1072.
  23. 23.Forman DE, Butler J, Wang Y, Abraham WT, O’Connor CM, Gottlieb SS. Incidence, Predictors at Admission, and Impact of Worsening Renal Function among Patients Hospitalized with Heart Failure. Journal of the American College of Cardiology 2004; 43(1): 61–67.
  24. 24.Costanzo MR. Cardiorenal syndrome in heart failure patients I . Cardiorenal Syndrome :What every physician needs to know . II . Diagnostic Confirmation : Are you sure your patient has Cardiorenal Syn- Majmaah Journal of Health Sciences ,Vol. 9, Issue 2, April - 2021, Shaban - 1442 35 Prevalence, Predictors and Prognostic Impact of Renal Dysfunction among Hospitalized Patients with Systolic Heart Failure drome ? 2019;1–33.
  25. 25.Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM. Hemoglobin Level, Chronic Kidney Disease, and the Risks of Death and Hospitalization in Adults With Chronic Heart Failure. Circulation 2006; 113(23): 2713–2723.
  26. 26.Cheitlin M. Renal Function as a Predictor of Outcome in a Broad Spectrum of Patients With Heart Failure. Yearbook of Cardiology 2007; 327-328.
  27. 27.Tarantini L, Cioffi G, Gonzini L, Oliva F, Lucci D, Di Tano G. Evolution of renal function during and after an episode of cardiac decompensation: results from the Italian survey on acute heart failure. Journal of Cardiovascular Medicine 2010; 11(4): 234-243.
  28. 28.McAlister F, Ezekowitz J, Tonelli M, Armstrong P. Renal Insufficiency and Heart Failure. Circulation 2004; 109(8): 1004-1009.
  29. 29.Afsar B, Ortiz A, Covic A, Solak Y, Goldsmith D, Kanbay M. Focus on renal congestion in heart failure. Clinical Kidney Journal 2015; 9(1):39-47.
  30. 30.Smilde T, Hillege H, Navis G, Boomsma F, de Zeeuw D, van Veldhuisen D. Impaired renal function in patients with ischemic and nonischemic chronic heart failure: association with neurohormonal activation and survival. American Heart Journal 2004; 148(1): 165-172.

Peer review

Peer reviewed by 2 reviewers, who chose to remain anonymous.

Majmaah Journal of Health Sciences · eISSN 1658-8223 · Majmaah University · open access