Risk Factors Of Worsening Renal Function In Patients With Chronic Heart Failure

ForewordAs a chronic disease, heart failure is the major cause of death in majority of cardiovascular diseases. In the course of heart failure, along with a number of serious complications, and have a major impact on prognosis, in which renal insufficiency is the most common, and have the greatest impact on prognosis, this phenomenon is clled cardiorenal syndrome, the high incidence rate of cardiorenal syndrome has been given high priority. A META analysis which assess the heart failure and renal dysfunction found that 63% of the patients had mild renal impairment,20% had moderate or severe renal insufficiency. In clinical also found that most patients hospitalized for heart failure occurs worsening renal function(WRF), the longer hospitalized, the higher incidence of WRF. To standard by creatinine increasing exceed 0.3mg/dl after admission, Forman et.al reported that 27% patients with chronic heart failure occurs WRF, and another standard of WRF by Creatinine increasing exceed 0.5mg/dl reported incidence of 21%. Heart failure patients with renal dysfunction had higher mortality and readmission rates, domestic and international studies found WRF in patients with heart failure were independent prognostic risk factors. This shows the universality and the importance of WRF. This study aimed to explore the risk factors of WRF in patients with heart failure, which may be contribute to clinical work and guide the future.ObjectiveTo study the risk factors of WRF in patients with chronic heart failure and the effect on prognosis.MethodsThis research was a case-control study, included 211 patients hospitalized with heart failure from cardiology department of shengjing hospital in July 2007～July 2009, 66 patients occurred WRF as case group,in the control group (no WRF) had 145 cases, two sets of data were collected, including medical history, physical examination, laboratory and physical examination results and other relevant information, established a database by spss16.0 software,calculated the incidence of worsening renal function in heart failure patients during hospitalization, using multivariate logistic regression analysis, after adjusting for confounding factors, obtained the independent risk factors of WRF,also observed the impact on prognosis.ResultIn 211 patients with heart failure,31% of patients renal function deteriorated. History of hypertension, diabetes, Cardiac function, admission creatinine, hemoglobin, hematocrit, brain natriuretic peptide, uric acid, diuretic amount,calcium antagonist used or not had a significant difference between the two groups (P＜0.05).in Analysis of single variables we found that hypertension, diabetes, anemia, low hematocrit, high brain natriuretic peptide (BNP), high uric acid, large dose of diuretic were risk factors of WRF. Into the multivariate analysis, admission creatinine levels and cardiac function occurred independently associated with WRF, OR values were 2.248 (95% CI:1.088～4.647) and 2.485 (95% CI:1.385～4.459). patients with WRF had significantly higher mortality during hospitalization, the risk ratio was 3.8.ConclusionIncidence of worsening of renal function in patients with heart failure was higher and significantly associated with mortality during hospitalization. Admission creatinine level is high and poor cardiac function in heart failure patients were independent risk factors.