Prevalence and significance of unrecognized renal insufficiency in patients with heart failure

Yoram Amsalem, Moshe Garty, Roseline Schwartz, Amir Sandach, Solomon Behar, Abraham Caspi, Shmuel Gottlieb, David Ezra, Basil S. Lewis, Jonathan Leor

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Renal insufficiency (RI) is a strong predictor of adverse outcome in patients with heart failure (HF). We aimed to determine the prevalence of RI being unrecognized and its significance in patients hospitalized with HF. Methods and results: We analysed data from a prospective survey of 4102 hospitalized patients with HF. RI [defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] was present in 2145 (57%) patients but, based on medical records, was unrecognized in 872 [41%, 95% confidence interval (CI) 39-43%] of them. Patients with unrecognized RI were more likely to be women, elderly, and with better functional class, compared with patients with recognized RI. In-hospital and 1 year mortality was significantly higher among patients with recognized and unrecognized RI compared with patients without RI: 6.5 and 7.1 vs. 2.1%, and 38.8 and 30.9 vs. 18.8% (P < 0.001), respectively. After adjustment, recognized and unrecognized RI comparably predicted increased in-hospital mortality: odds ratio (OR) and 95% CI of 2.34 (1.43-3.87), P < 0.001, and 2.30 (1.45-3.72), P < 0.001. After 1 year, recognized RI remained an independent predictor for mortality: OR 1.79 (1.45-2.20), P < 0.001, whereas there was a trend for increased mortality predicted by unrecognized RI: OR 1.22 (0.97-1.53), P = 0.08.ConclusionA high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR.

Original languageEnglish
Pages (from-to)1029-1036
Number of pages8
JournalEuropean Heart Journal
Volume29
Issue number8
DOIs
StatePublished - Apr 2008

Keywords

  • Glomerular filtration rate
  • Heart failure
  • Kidney
  • Prognosis
  • Renal insufficiency

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