High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database.

BACKGROUND: The prevalence of renal dysfunction in patients hospitalized with acute decompensated heart failure remains poorly characterized. METHODS AND
RESULTS: Data from 118,465 hospitalization episodes were evaluated. Glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease formula. At admission, 10,660 patients (9.0%) had normal renal function (GFR > or = 90 mL x min x 1.73 m2), 32,423 patients (27.4%) had mild renal dysfunction (GFR 60-89 mL x min x 1.73 m2), 51,553 patients (43.5%) had moderate renal dysfunction (GFR 30-59 mL.min.1.73 m2), 15,553 patients (13.1%) had severe renal dysfunction (GFR 15-29 mL x min x 1.73 m2), and 8276 patients (7.0%) had kidney failure (GFR < 15 mL x min x 1.73 m2 or chronic dialysis). Despite this, only 33.4% of men and 27.3% of women were diagnosed with renal insufficiency. Diuretic dose, inotrope use, and nesiritide use increased, whereas angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use decreased, with increasing renal dysfunction (all P < .0001 across stages). In-hospital mortality increased from 1.9% for patients with normal renal function to 7.6% and 6.5% for patients with severe dysfunction and kidney failure, respectively (P < .0001).
CONCLUSIONS: The majority of patients admitted with acute decompensated heart failure have significant renal impairment, which influences treatment and outcomes.