Advertisement

Comparison of risk factors for acute worsening renal function in heart failure patients with and without preserved ejection fraction

Published:August 19, 2015DOI:https://doi.org/10.1016/j.ejim.2015.08.003

      Highlights

      • We assessed risk factors for acute worsening renal function in HF patients.
      • Hypertension is associated with AWRF in both HFpEF and HFrEF patients.
      • A history of hypertension was important as a risk factor for AWRF in HFpEF.
      • On the other hand, high blood pressure at admission was important in HFrEF.
      • Calcium channel blocker was an independent risk factor in HFpEF, but not in HFrEF.

      Abstract

      Objective

      We compared the risk factors for acute worsening renal function (AWRF) in patients with acute decompensated heart failure with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF).

      Methods

      We retrospectively studied 181 consecutive patients. AWRF was defined as a rise in serum creatinine of ≥0.3 mg/dL from admission to day 3. Potential risk factors of AWRF were identified in univariate analyses; then logistic regression analysis with backward stepwise selection was performed.

      Results

      In the present study of limited sample size, 46% had HFpEF (EF ≥ 50%) and 54% had HFrEF (EF < 50%). In the HFpEF group, history of hypertension (odds ratio [OR] 32.46, 95% CI 2.39–440.12, P = 0.009), the increased serum potassium value at admission (OR 4.61, 95% CI 1.14–18.73, P = 0.032), and the pretreatment with calcium channel blocker (OR 8.52, 95% CI 1.21–60.09, P = 0.032) were independent risk factors (defined as P < 0.05 and OR > 1.01) for AWRF. In contrast, diastolic blood pressure at admission (OR 1.07, 95% CI 1.02–1.13, P = 0.004) was the sole independent risk factor for AWRF in the HFrEF group.

      Conclusions

      Hypertension was associated with AWRF in both HFpEF and HFrEF patients. A history of hypertension was more important than elevated blood pressure at admission as a risk factor for AWRF in HFpEF, whereas the reverse was observed for HFrEF. Among antihypertensive drugs, pretreatment with calcium channel blocker was an independent risk factor for AWRF in HFpEF, but not in HFrEF.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Forman D.E.
        • Butler J.
        • Wang Y.
        • Abraham W.T.
        • O'Connor C.M.
        • Gottlieb S.S.
        • et al.
        Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure.
        J Am Coll Cardiol. 2004; 43: 61-67
        • Metra M.
        • Nodari S.
        • Parrinello G.
        • Bordonali T.
        • Bugatti S.
        • Danesi R.
        • et al.
        Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance.
        Eur J Heart Fail. 2008; 10: 188-195
        • Hata N.
        • Yokoyama S.
        • Shinada T.
        • Kobayashi N.
        • Shirakabe A.
        • Tomita K.
        • et al.
        Acute kidney injury and outcomes in acute decompensated heart failure: evaluation of the RIFLE criteria in an acutely ill heart failure population.
        Eur J Heart Fail. 2010; 12: 32-37
        • Krumholz H.M.
        • Chen Y.-T.
        • Vaccarino V.
        • Wang Y.
        • Radford M.J.
        • Bradford W.D.
        • et al.
        Correlates and impact on outcomes of worsening renal function in patients ≥65 years of age with heart failure.
        Am J Cardiol. 2000; 85: 1110-1113
        • Butler J.
        • Forman D.E.
        • Abraham W.T.
        • Gottlieb S.S.
        • Loh E.
        • Massie B.M.
        • et al.
        Relationship between heart failure treatment and development of worsening renal function among hospitalized patients.
        Am Heart J. 2004; 147: 331-338
        • Cowie M.R.
        • Komajda M.
        • Murray-Thomas T.
        • Underwood J.
        • Ticho B.
        Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH).
        Eur Heart J. 2006; 27: 1216-1222
        • Owan T.E.
        • Hodge D.O.
        • Herges R.M.
        • Jacobsen S.J.
        • Roger V.L.
        • Redfield M.M.
        Trends in prevalence and outcome of heart failure with preserved ejection fraction.
        N Engl J Med. 2006; 355: 251-259
        • Tribouilloy C.
        • Rusinaru D.
        • Mahjoub H.
        • Soulière V.
        • Lévy F.
        • Peltier M.
        • et al.
        Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study.
        Eur Heart J. 2008; 29: 339-347
        • Udelson J.E.
        Heart failure with preserved ejection fraction.
        Circulation. 2011; 124: e540-e543
        • Bishu K.
        • Redfield M.M.
        Acute heart failure with preserved ejection fraction: unique patient characteristics and targets for therapy.
        Curr Heart Fail Rep. 2013; 10: 190-197
        • Borlaug B.A.
        The pathophysiology of heart failure with preserved ejection fraction.
        Nat Rev Cardiol. 2014; 11: 507-515
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • Benjamin E.J.
        • Berry J.D.
        • Blaha M.J.
        • et al.
        Heart disease and stroke statistics—2014 update: a report from the American Heart Association.
        Circulation. 2014; 129: e28-e292
        • Pitt B.
        • Segal R.
        • Martinez F.A.
        • Meurers G.
        • Cowley A.J.
        • Thomas I.
        • et al.
        Randomised trial of losartan versus captopril in patients over 65 with heart failure (evaluation of Losartan in the Elderly Study, ELITE).
        Lancet. 1997; 349: 747-752
        • Abassi Z.
        • Gurbanov K.
        • Rubinstein I.
        • Better O.S.
        • Hoffman A.
        • Winaver J.
        Regulation of intrarenal blood flow in experimental heart failure: role of endothelin and nitric oxide.
        Am J Physiol. 1998; 274: F766-F774
        • Friedrich E.B.
        • Muders F.
        • Luchner A.
        • Dietl O.
        • Riegger G.A.
        • Elsner D.
        Contribution of the endothelin system to the renal hypoperfusion associated with experimental congestive heart failure.
        J Cardiovasc Pharmacol. 1999; 34: 612-617
        • Lee D.S.
        • Gona P.
        • Vasan R.S.
        • Larson M.G.
        • Benjamin E.J.
        • Wang T.J.
        • et al.
        Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute.
        Circulation. 2009; 119: 3070-3077
        • Oktay A.A.
        • Shah S.J.
        Current perspectives on systemic hypertension in heart failure with preserved ejection fraction.
        Curr Heart Fail Rep. 2014; 16: 545
        • Sarraf M.
        • Masoumi A.
        • Schrier R.W.
        Cardiorenal syndrome in acute decompensated heart failure.
        Clin J Am Soc Nephrol. 2009; 4: 2013-2026
        • Loutzenhiser R.
        • Epstein M.
        • Horton C.
        • Hamburger R.
        Nitrendipine-induced stimulation of renin release by the isolated perfused rat kidney.
        Proc Soc Exp Biol Med. 1985; 180: 133-136
        • Imagawa J.
        • Kurosawa H.
        • Satoh S.
        Effects of nifedipine on renin release and renal function in anesthetized dogs.
        J Cardiovasc Pharmacol. 1986; 8: 636-640
        • Jones-Dombi T.
        • Churchill P.
        The baroreceptor mechanism for controlling renin secretion: effect of calcium channel blockers.
        J Pharmacol Exp Ther. 1993; 266: 274-278
        • Beierwaltes W.H.
        The role of calcium in the regulation of renin secretion.
        Am J Physiol Renal Physiol. 2010; 298: F1-F11
        • Matsushita K.
        • Zhang Z.
        • Pratt R.E.
        • Dzau V.J.
        Molecular mechanism of juxtaglomerular cell hyperplasia: a unifying hypothesis.
        J Am Soc Hypertens. 2007; 1: 164-168
        • Friis U.G.
        • Madsen K.
        • Stubbe J.
        • Hansen P.B.L.
        • Svenningsen P.
        • Bie P.
        • et al.
        Regulation of renin secretion by renal juxtaglomerular cells.
        Pflugers Arch. 2013; 465: 25-37
        • Lazzeri C.
        • Valente S.
        • Tarquini R.
        • Gensini G.F.
        Cardiorenal syndrome caused by heart failure with preserved ejection fraction.
        Int J Nephrol. 2011; 2011: 634903
        • Wright J.T.
        • Bakris G.
        • Greene T.
        • Agodoa L.Y.
        • Appel L.J.
        • Charleston J.
        • et al.
        Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial.
        JAMA. 2002; 288: 2421-2431
        • Knight E.L.
        • Glynn R.J.
        • McIntyre K.M.
        • Mogun H.
        • Avorn J.
        Predictors of decreased renal function in patients with heart failure during angiotensin-converting enzyme inhibitor therapy: results from the studies of left ventricular dysfunction (SOLVD).
        Am Heart J. 1999; 138: 849-855