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Recently, the Kidney Disease Improving Global Outcomes (KDIGO) guideline proposed that we should add albuminuria to estimated glomerular filtration rate (eGFR) in classifying chronic kidney disease. However, only a few studies using the KDIGO classification are available in hospitalized patients due to heart failure (HF). We investigated whether the KDIGO classification has incremental prognostic value in such patients.
We studied 137 consecutive patients who hospitalized due to HF. Blood and urinary samples were obtained at discharge. Patients were categorized by KDIGO classification into 4 groups according to the eGFR and the urinary albumin-to-creatinine ratio as preserved, mild, moderate, and severe kidney dysfunction groups. These patients were followed prospectively regarding the occurrence of either all-cause mortality and re-hospitalizations due to HF. Cut-off value of the other biomarkers for prediction of the events was identified using ROC curves. Kaplan-Meier event curves were compared using log-rank tests. Multivariate Cox proportional hazard analysis was adjusted for age, gender, body mass index, left ventricular (LV) ejection fraction, prevalence of hypertension or diabetes mellitus, administrated drugs, B-type natriuretic peptide and significant parameters.
Patients were followed for a median of 8.6 months. 23 patients died and 38 were re-hospitalized due to HF. KDIGO classification, hemoglobin, administration of calcium channel blocker, and troponin-T levels were predictors of combined all-cause mortality and HF rehospitalization (log lank, p<0.0001, p=0.0008, p=0.0013, and p=0.0041, respectively). In multivariate Cox proportional hazard analysis, only KDIGO classification and hemoglobin were the predictors of the event (p=0.007, hazard ratio 2.1, 95% confidence interval 1.83 to 2.39, and p=0.006, hazard ratio 0.75, 95% confidence interval 0.64 to 0.85, respectively).
This study demonstrates that KDIGO classification is promising to predict mortality and HF re-hospitalization in HF patients independent of LV dysfunction and anemia.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Lessons Learned from Acute Decompensated Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1175-288
- 2013 American College of Cardiology Foundation