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| |  Heart Failure Patients With Kidney Dysfunction Fare Poorly After Hospital Discharge: Presented at AHA By Ed Susman ORLANDO, Fla -- November 19, 2009 -- Researchers suggested here, at the American Heart Association (AHA) Scientific Sessions 2009, that heart failure patients who are sent home from the hospital with persistent kidney deterioration have an increased risk of death or rehospitalisation during the 12 months following their release. In fact, researchers also found that heart failure patients who are diagnosed in the hospital with even transient renal problems appear to have a gloomier outlook. “Even temporary kidney trouble in the hospital showed a trend toward poor 1-year outcomes but persistent kidney dysfunction was definitely worse with long-term implications,” said David Lanfear, MD, Henry Ford Hospital, Detroit, Michigan, on November 17. In the study, Dr. Lanfear and colleagues followed 2,537 heart failure patients who were discharged from Henry Ford Hospital between January 1, 2000, and June 30, 2008. Among patients whose kidney function worsened in the hospital, 61% did not recover from it before discharge and their risk of further health problems increased. Meanwhile, 39% of patients experienced kidney dysfunction that was short-lived and was not a significant predictor of increased mortality or rehospitalisation. Patients with end-stage renal disease were excluded. Renal function during the index hospitalisation was assessed using serial creatinine values, with the first creatinine level at the index visit considered a baseline measurement. An increase of 0.3 mg/dL in creatinine on any day in the hospital was defined as worsening renal failure. Of the patients in the study, 49.1% were women and 50.6% were African American, Dr. Lanfear reported. “After adjustment for baseline covariates, persistent worsening renal failure was independently associated with a 24% increased risk of mortality and 14% (hazard ratio [HR] = 1.24; 95% confidence interval [CI], 1.09-1.42) increased risk of and rehospitalisation (HR = 1.14; 95% CI, 1.02-1.27). Transient worsening renal failure increased the risk of mortality (HR = 1.08; 95% CI, 0.92-1.27) and rehospitalisation (HR= 1.08; 95% CI, 0.92-1.27) by about 8% -- although this failed to reach statistical significance. “We need to better understand why kidney dysfunction persists in some patients and what can be done to avert it,” said Dr. Lanfear. Funding for this study was provided by Merck. [Presentation title: Reversibility of Worsened Renal Function During Acute Heart Failure Hospitalization and Association With Subsequent Outcomes. Abstract 1350]
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