Clinical InvestigationWorsening Renal Function and Prognosis in Heart Failure: Systematic Review and Meta-Analysis
Section snippets
Literature Search
MEDLINE was searched to identify eligible studies using search tools provided by PubMed (http://www.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtml; accessed January 2007). These search tools have been validated by Haynes et al as optimizing retrieval.6 We also used keywords including (worsening) renal (kidney) function, WRF, heart failure, mortality, prognosis, left ventricular dysfunction, creatinine, and a combination of these. We included articles limited to the English language.
Study Search and General Characteristics
Of 1124 citations retrieved by the search, 13 investigated the relationship between WRF and outcome. Five studies were excluded for reasons shown in Fig. 1.11, 12, 13, 14, 15 Eight studies remained for our analysis.7, 8, 16, 17, 18, 19, 20, 21 Of all selected studies, 3 assessed deteriorating renal function in outpatients,7, 18, 20 whereas the remaining 5 investigated patients in the in-hospital setting8, 16, 17, 19, 21 with follow-up extending beyond admission. One study described the
Discussion
To our knowledge, this is the first systematic review to address the relation between WRF and outcome in patients with HF. WRF was common, whether defined by increase in serum creatinine or eGFR, especially in patients with impaired renal function at baseline. It was associated with an increase in mortality and all-cause hospitalization especially when WRF was more severe. This was true whether WRF occurred in the setting of acute or chronic HF. On the other hand, improvement in renal function,
Conclusion
Worsening of renal function is commonly observed in patients with HF, especially in those who already have renal dysfunction. WRF is associated with an increase in all-cause mortality, especially in patients with more severe WRF, and all cause. On the other hand, improvement of kidney function is associated with better survival. Therefore therapy targeted at improving kidney function in HF may be a valuable new strategy to improve prognosis in this high-mortality patient group. Further research
Acknowledgment
The authors thank Dr. N. Kahn and Dr. I. Ma of the University of British Columbia, Vancouver, British Columbia, and Dr. A.S. Rigby, Dr. K. Goode, and Dr. R. de Silva of the Castle Hill Hospital, University of Hull, Cottingham, United Kingdom, for providing us with crude mortality data that was not available in their original reports.
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Kevin Damman is supported by The Netherlands Heart Foundation (grant 2006B157).