What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic heart failure (n=141). Intervention: Chronic kidney disease (GFR 60 ml/min/1.73 m2. Primary outcome: 1-year mortality (p=0.505).

January 1, 2014Open Access

HEART AND LUNG FAILURE, TRANSPLANTOLOGY The impact of chronic kidney disease on the annual prognosis in patients 80+ years old suffering from chronic heart failure

Key Result

Chronic kidney disease was associated with a 16.1% annual mortality rate in patients aged 80 and older with chronic heart failure, which was not statistically significantly different from those without chronic kidney disease (p=0.505).

Study Design

Type

Cohort (n=141)

Multicenter

Structured PICO

Does chronic kidney disease predict 1-year follow-up mortality in hospitalized chronic heart failure patients aged 80 and older?

Population

141 consecutive patients aged 80-92 (mean age 82.4 years, 44.7% men) hospitalized for chronic heart failure (CHF)

Intervention

Chronic kidney disease (CKD) defined as estimated GFR < 60 ml/min/1.73 m2 or GFR < 30 ml/min/1.73 m2

Comparator

Patients with GFR > 60 ml/min/1.73 m2

Outcome

1-year follow-up mortalityhard clinical

In octogenarians and nonagenarians hospitalized for chronic heart failure, chronic kidney disease was highly prevalent but did not significantly predict 1-year mortality.

Main Result

p-value: p=0.505

Limitations

Relatively small number of participants
Use of baseline weight in calculating creatinine clearance by Cockcroft-Gault's model may overestimate clearance due to fluid overload
Calculated creatinine clearance tends to overestimate GFR
Lack of particular data on urinalyses or structural abnormalities of the kidneys
Hospital-based, short-term study that did not include outpatients

Abstract

INTRODUCTION: It is well known that the function of kidneys is impaired with age. AIM: The purpose of the study was to evaluate whether chronic kidney disease (CKD) is a predictor for 1-year follow-up mortality among hospitalized chronic heart failure (CHF) patients aged 80+. MATERIAL AND METHODS: The study included 141 consecutive patients aged 80-92 (mean: 82.4 years, 44.7% men). The prospective analysis contains 61 variables with glomerular filtration rate (GFR) and the occurrence of death at the 1-year follow-up. Patients were divided and analyzed depending on GFR. RESULTS: Chronic kidney disease defined as estimated GFR < 60 ml/min/1.73 m(2) was recorded in 93 patients (66%). A relationship with GFR < 60 was found for older age (p = 0.0001), lower body mass index - BMI (p = 0.003), more advanced NYHA class III (p = 0.007), higher concentrations of N-terminal probrain natriuretic peptide - NT-proBNP (p = 0.023), lower hemoglobin (p = 0.0004) and LVEF (p = 0.005), longer hospitalization (p = 0.005), more frequent ventricular blocks in ECG (p = 0.017) and rarely performed coronary angiography (p = 0.021). In turn, GFR < 30 ml/min/1.73 m(2) was recorded in 14 patients (9.9%). Similar relationships as in GFR < 60 were found for GFR < 30 and additionally higher concentrations of high-sensitivity C-reactive protein (hsCRP) (p = 0.003), D-dimer (p = 0.002) and more frequent dyslipidemia (p = 0.004) and left main coronary artery disease (p = 0.007). Annual mortality for the total population was 14.2% (n = 20) and was higher (16.1%) if GFR was < 60 and even more (21.4%) in GFR < 30. However, the relationship between deaths and GFR was not statistically significant (for GFR < 60, p = 0.505 and GFR < 30, p = 0.547). CONCLUSIONS: Annual mortality in the patients 80+ who suffered from CHF was high but not statistically significantly associated with CKD.

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