The Paramount Importance of Renal Dysfunction in Heart Failure Prognosis - Results from the REFERENCE study / La importancia primordial de la disfunción renal en el pronóstico de la insuficiencia cardíaca - Resultados del estudio REFERENCE

ABSTRACT

Aims: In heart failure patients renal dysfunction represents impaired tissue perfusion. We investigated the association of customarily used renal function parameters with short-term prognosis in patients admitted with acute decompensated heart failure in class III or IV of New York Heart Association. Material and Methods: Univariate Cox proportional hazard model was used to assess the relationship between variables and outcomes. Survival curves were designed using the Kaplan-Meier method. Results: We followed 65 patients for a median of 13.7 (Q1-Q3 6.7-18.9) months. Variables associated with an increased risk for short-term rehospitalization were baseline urea (HR 1.098, 95% CI 1.022-1.179, P-value=0.01), admission urea (HR 1.048, 95% CI 1.013-1.084, P-value=0.006), baseline creatinine (HR 1.111, 95% CI 1.004-1.229, P-value=0.041), admission creatinine (HR 1.047, 95% CI 1.005-1.092, P-value=0.027) and admission glomerular filtration rate <30 mL/min (HR 3.535, 95% CI 1.467-8.518, P-value=0.005). Increased risk for short-term mortality was associated with baseline urea (HR 1.145, 95% CI 1.032-1.270, P-value=0.010), admission urea (HR 1.076, 95% CI 1.021-1.135, P-value=0.006), baseline creatinine (HR 1.157, 95% CI 1.009-1.328, P value=0.037), admission creatinine (HR 1.127, 95% CI 1.055-1.204, P-value<0.001) and admission glomerular filtration rate <30 mL/min (HR 9.791, 95% CI 2.855-33.580, P-value<0.001). Variables associated with an increased risk for end of follow-up mortality were admission urea (HR 1.056, 95% CI 1.019-1.094, P-value=0.003), admission creatinine (HR 1.104, 95% CI 1.054-1.156, P- value<0.001) and admission glomerular filtration rate <30 mL/min (HR 3.906, 95% CI 1.7208.871, P- value=0.001). Conclusion: Renal dysfunction was a reliable predictor of worse prognosis as several parameters correlated with short-term prognosis. (AU)

RESUMEN

Introducción: En la insuficiencia cardíaca, la disfunción renal representa hipoperfusión tisular. Investigamos la asociación entre parámetros utilizados cotidianamente y el pronóstico precoz de enfermos ingresados por insuficiencia cardíaca descompensada en clase III o IV de la New York Heart Association. Material y métodos: Aplicamos el modelo de riesgo proporcional de Univariante Cox y curvas de supervivencia de Kaplan-Meier. Resultados: La mediana de seguimiento de los 65 enfermos fue de 13.7 (Q1-Q3 6.7-18.9) meses. Se correlacionaron con el reingreso precoz la urea basal (HR 1.098, 95% CI 1.022-1.179, P-value=0.01), la urea al ingreso (HR 1.048, 95% CI 1.013-1.084, P-value=0.006), la creatinina basal (HR 1.111, 95% CI 1.004-1.229, P-value=0.041), creatinina al ingreso (HR 1.047, 95% CI 1.005-1.092, P-value=0.027) y la tasa de filtración glomerular <30 mL/min al ingreso <30 mL/min (HR 3.535, 95% CI 1.467-8.518, P-value=0.005). El riesgo de mortalidad precoz se correlacionó con la urea basal (HR 1.145, 95% CI 1.032-1.270, P-value=0.010), la urea al ingreso (HR 1.076, 95% CI 1.021-1.135, P-value=0.006), la creatinina basal (HR 1.157, 95% CI 1.009-1.328, P value=0.037), creatinina al ingreso (HR 1.127, 95% CI 1.055-1.204, P-value<0.001) y la tasa de filtración glomerular <30 mL/min al ingreso <30 mL/min (HR 9.791, 95% CI 2.855-33.580, P-value<0.001). Se correlacionarón con la mortalidad al final del seguimiento la urea al ingreso (HR 1.056, 95% CI 1.019-1.094, P-value=0.003), la creatinina al ingreso (HR 1.104, 95% CI 1.054-1.156, P- value<0.001) y la tasa de filtración glomerular <30 mL/min al ingreso (HR 3.906, 95% CI 1.7208.871, P- value=0.001). Conclusiones: La disfunción renal fue un predictor de peor pronóstico precoz. (AU)