Prognostic impact of renal dysfunction does not differ according to the clinical profiles of patients: Insight from the acute decompensated heart failure syndromes (ATTEND) registry

Taku Inohara, Shun Kosaka, Naoki Sato, Katsuya Kajimoto, Takehiko Keida, Masayuki Mizuno, Teruo Takano

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Renal dysfunction associated with acute decompensated heart failure (ADHF) is associated with impaired outcomes. Its mechanism is attributed to renal arterial hypoperfusion or venous congestion, but its prognostic impact based on each of these clinical profiles requires elucidation. Methods and Results: ADHF syndromes registry subjects were evaluated (N=4,321). Logistic regression modeling calculated adjusted odds ratios (OR) for in-hospital mortality for patients with and without renal dysfunction. Renal dysfunction risk was calculated for subgroups with hypoperfusion-dominant (eg. cold extremities, a low mean blood pressure or a low proportional pulse pressure) or congestion-dominant clinical profiles (eg. peripheral edema, jugular venous distension, or elevated brain natriuretic peptide) to evaluate renal dysfunction's prognostic impact in the context of the two underlying mechanisms. On admission, 2,150 (49.8%) patients aged 73.3±13.6 years had renal dysfunction. Compared with patients without renal dysfunction, those with renal dysfunction were older and had dominant ischemic etiology jugular venous distension, more frequent cold extremities, and higher brain natriuretic peptide levels. Renal dysfunction was associated with in-hospital mortality (OR 2.36; 95% confidence interval 1.75-3.18, p<0.001), and the prognostic impact of renal dysfunction was similar in subgroup of patients with hypoperfusion- or congestion-dominant clinical profiles (p-value for the interaction ranged from 0.104-0.924, and was always >0.05). Conclusions: Baseline renal dysfunction was significantly associated with in-hospital mortality in ADHF patients. The prognostic impact of renal dysfunction was the same, regardless of its underlying etiologic mechanism.

Original languageEnglish
Article numbere105596
JournalPLoS One
Volume9
Issue number9
DOIs
Publication statusPublished - 2014 Sep 8

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heart failure
Registries
Heart Failure
Brain Natriuretic Peptide
kidneys
Kidney
Blood pressure
Logistics
Hospital Mortality
natriuretic peptides
odds ratio
neck
Neck
Extremities
Odds Ratio
brain
hypotension
Hyperemia
Hypotension
edema

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Prognostic impact of renal dysfunction does not differ according to the clinical profiles of patients : Insight from the acute decompensated heart failure syndromes (ATTEND) registry. / Inohara, Taku; Kosaka, Shun; Sato, Naoki; Kajimoto, Katsuya; Keida, Takehiko; Mizuno, Masayuki; Takano, Teruo.

In: PLoS One, Vol. 9, No. 9, e105596, 08.09.2014.

Research output: Contribution to journalArticle

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abstract = "Background: Renal dysfunction associated with acute decompensated heart failure (ADHF) is associated with impaired outcomes. Its mechanism is attributed to renal arterial hypoperfusion or venous congestion, but its prognostic impact based on each of these clinical profiles requires elucidation. Methods and Results: ADHF syndromes registry subjects were evaluated (N=4,321). Logistic regression modeling calculated adjusted odds ratios (OR) for in-hospital mortality for patients with and without renal dysfunction. Renal dysfunction risk was calculated for subgroups with hypoperfusion-dominant (eg. cold extremities, a low mean blood pressure or a low proportional pulse pressure) or congestion-dominant clinical profiles (eg. peripheral edema, jugular venous distension, or elevated brain natriuretic peptide) to evaluate renal dysfunction's prognostic impact in the context of the two underlying mechanisms. On admission, 2,150 (49.8{\%}) patients aged 73.3±13.6 years had renal dysfunction. Compared with patients without renal dysfunction, those with renal dysfunction were older and had dominant ischemic etiology jugular venous distension, more frequent cold extremities, and higher brain natriuretic peptide levels. Renal dysfunction was associated with in-hospital mortality (OR 2.36; 95{\%} confidence interval 1.75-3.18, p<0.001), and the prognostic impact of renal dysfunction was similar in subgroup of patients with hypoperfusion- or congestion-dominant clinical profiles (p-value for the interaction ranged from 0.104-0.924, and was always >0.05). Conclusions: Baseline renal dysfunction was significantly associated with in-hospital mortality in ADHF patients. The prognostic impact of renal dysfunction was the same, regardless of its underlying etiologic mechanism.",
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