| Objective:To study and research the incidence rate and clinical feature of chronic heart failure in the elderly with renal dysfunction,and analyze the effect of renal dysfunction on hospital mortality,2 years mortality after invasion and hospitalization rate of repeated heart failure in chronic heart failure in the elderly with renal dysfunction.Material and Methods:291 eldly CHF patients which first time admitted in chinses PLA general hospital from Oct 2005 to Oct 2008 were applied with retrospective case analysis. Clinical data of patients first time admitted were recorded including general case, morbility reason, complicating disease, clinical manifestation,therapy drug,laboratory results, echocardiogram results. Modified glomerular filtration rate (GFR) Estimating Equation for Chinese Patients was used to evaluated the patients' renal function:eGFR(ml.min-1.1.73m-2)=186×[Cr]-1.154×[age]-0.203×1.233 (female×0.742), (cr:mg/dl, 1mg/dl=88.4μmol/l).According to eGFR,253 patients which were selected in this study were divided into three groups:the normal renal function group (eGFR≥90 ml.min-1.1.73m-2), the mild renal function damage group (60≤eGFR<90 ml.min-1.1.73m-2), the renal dysfunction group (eGFR<60 ml.min-1.1.73m-2). Clinical data were analyzed including general case, morbility reason,complicating disease, clinical manifestation,therapy drug,laboratory results,echocardiogram results. Hospital mortality and 2 years mortality after invasion were main study end-point of this study; hospitalization rate of repeated heart failure,palindromic coronary artery event, malignant arrhythmia,cerebral apoplexy were secondary end-point of this study. Hospital mortality,2 years mortality after invasion, hospitalization rate of repeated heart failure,palindromic coronary artery event,malignant arrhythmia,cerebral apoplexy were analyzed. The mortality and hospitalization rate of repeated heart failure were analyzed by logistic regression. Results:253 cases were enrolled.The median age of the patients was 78 years old.There were 168 males (66.4%)and 85 (33.6%) famales.The patients' heart function grade were NYHAⅡ-Ⅳ,123 patients'(48.6%) heart function grade were NYHAⅡ, 83 patients'(32.8%) heart function grade were NYHAⅢ,47 patients'(18.6%) heart function grade were NYHAⅣ.106 patients'(41.9%) renal function were normal,87 patients (34.4%) had mild renal function damage,60 patients(23.7%) had renal dysfunction.Compared with the normal renal function group and the mild renal function damage group,the CHF with renal dysfunction patients were elder, the proportion of heart function grade NYHA II was fewer, the proportion of heart function grade NYHAⅣwas more. The complication proportion of hypertension, old myocardial infarction, acute myocardial infarction, diabetes, pulmonary infection,anemia was higher. The clinical symptom proportion of paroxysmal dyspnea, dyspnea on exertion, basis pulmonis rales, acute pulmonary edema, edema of lower extremity, urine volume decrease, weight gain was higher.The level of CRP, NT-proBNP was higher. The level of eGFR,LVEF was lower. The therapy drug proportion of ACEI,ARB,β-receptor blocker was lower; the proportion of diuretic was higher(P<0.05). Compared with the normal renal function group and the mild renal function damage group, hospital mortality,2 years mortality after invasion,hospitalization rate of repeated heart failure,the incidence of palindromic coronary artery event and malignant arrhythmia were higher;the death time to fall ill was shorter;the hospitalization number of repeated heart failure increased; the time of first time hospitalization and total time of hospitalization in 2 years were longer;the death reason proportion of heart failure and malignant arrhythmia was higher(p<0.05). Renal dysfunction was an independent risk factor to hospital mortality,2 years mortality after invasion and hospitalization rate of repeated heart failure.Conclusions:The incidence rate of renal dysfunction was higher in eldly CHF patients;the patients with renal dysfunction were elder; the heart function was much worser.Compared with the normal renal function group, the complication proportion of old myocardial infarction,acute myocardial infarction,hypertension,diabetes, pulmonary infection,anemia was more common;the level of CRP, NT-proBNP was higher; the therapy drug proportion of ACEI was lower; the proportion of diuretic and spironolactone was higher.The mortality,2 years mortality after invasion, the incidence of palindromic coronary artery event and malignant arrhythmia increased; death because of heart failure and malignant arrhythmia was more common;the hospitalization rate and number of repeated heart failure increased;the time of first time hospitalization and total time of hospitalization in 2 years were long. Renal dysfunction was an independent risk factor to hospital mortality,2 years mortality after invasion and hospitalization rate of repeated heart failure.
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