Renal impairment and outcomes in heart failure: systematic review and meta-analysis - PubMed (original) (raw)
Review
. 2006 May 16;47(10):1987-96.
doi: 10.1016/j.jacc.2005.11.084. Epub 2006 Apr 24.
Affiliations
- PMID: 16697315
- DOI: 10.1016/j.jacc.2005.11.084
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Review
Renal impairment and outcomes in heart failure: systematic review and meta-analysis
Grace L Smith et al. J Am Coll Cardiol. 2006.
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Abstract
Objectives: We estimated the prevalence of renal impairment in heart failure (HF) patients and the magnitude of associated mortality risk using a systematic review of published studies.
Background: Renal impairment in HF patients is associated with excess mortality, although precise risk estimates are unclear.
Methods: A systematic search of MEDLINE (through May 2005) identified 16 studies characterizing the association between renal impairment and mortality in 80,098 hospitalized and non-hospitalized HF patients. All-cause mortality risks associated with any renal impairment (creatinine >1.0 mg/dl, creatinine clearance [CrCl] or estimated glomerular filtration rate [eGFR] <90 ml/min, or cystatin-C >1.03 mg/dl) and moderate to severe impairment (creatinine > or =1.5, CrCl or eGFR <53, or cystatin-C > or =1.56) were estimated using fixed-effects meta-analysis.
Results: A total of 63% of patients had any renal impairment, and 29% had moderate to severe impairment. After follow-up > or =1 year, 38% of patients with any renal impairment and 51% with moderate to severe impairment died versus 24% without impairment. Adjusted all-cause mortality was increased for patients with any impairment (hazard ratio [HR] = 1.56; 95% confidence interval [CI] 1.53 to 1.60, p < 0.001) and moderate to severe impairment (HR = 2.31; 95% CI 2.18 to 2.44, p < 0.001). Mortality worsened incrementally across the range of renal function, with 15% (95% CI 14% to 17%) increased risk for every 0.5 mg/dl increase in creatinine and 7% (95% CI 4% to 10%) increased risk for every 10 ml/min decrease in eGFR.
Conclusions: Renal impairment is common among HF patients and confers excess mortality. Renal function should be considered in risk stratification and evaluation of therapeutic strategies for HF patients.
Comment in
- Does renal impairment increase mortality risk in patients with heart failure?
Cowie MR. Cowie MR. Nat Clin Pract Cardiovasc Med. 2007 Jan;4(1):20-1. doi: 10.1038/ncpcardio0705. Nat Clin Pract Cardiovasc Med. 2007. PMID: 17180144 No abstract available.
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