Worsening renal function in patients with acute decompensated heart failure treated with ultrafiltration

Predictors and outcomes

Eugenia Raichlin, Nicholas A. Haglund, Ioana Dumitru, Elizabeth R. Lyden, Michael D. Johnston, Joan M. Mack, John Robert Windle, Brian D Lowes

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Ultrafiltration (UF) is used to treat patients with diuretic-resistant acute decompensated heart failure. The aim of this study was to identify predictors and the effect of worsening renal failure (WRF) on mortality in patients treated with UF. Methods and Results Based on changes in serum creatinine, 99 patients treated with UF were divided into WRF and control groups. Overall creatinine increased from 1.9 ± 9.7 to 2.2 ± 2.0 mg/dL (P <.001), and WRF developed in 41% of the subjects. The peak UF rate was higher in the WRF group in univariate analysis (174 ± 45 vs 144 ± 42 mL/h; P =.03). Based on multivariate analysis, aldosterone antagonist treatment (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.17-13.46, P =.04), heart rate ≤65 beats/min (OR 6.03, 95% CI 1.48-48.42; P =.03), and E/E′ ≥15 (OR 3.78, 95% CI 1.26-17.55; P =.04) at hospital admission were associated with WRF. Patients with baseline glomerular filtration rate (GFR) ≤60 mg/dL who developed WRF during UF had a 75% 1-year mortality rate. Conclusions WRF occurred frequently during UF. Increased LV filling pressures, lower heart rate, and treatment with aldosterone antagonist at hospital admission can identify patients at increased risk for WRF. Patients with baseline GFR ≤60 mg/dL and WRF during UF have an extremely high 1-year mortality rate.

Original languageEnglish (US)
Pages (from-to)787-794
Number of pages8
JournalJournal of Cardiac Failure
Volume19
Issue number12
DOIs
StatePublished - Dec 1 2013

Fingerprint

Ultrafiltration
Renal Insufficiency
Heart Failure
Kidney
Mineralocorticoid Receptor Antagonists
Odds Ratio
Confidence Intervals
Glomerular Filtration Rate
Mortality
Creatinine
Heart Rate
Diuretics
Multivariate Analysis
Pressure
Control Groups
Therapeutics
Serum

Keywords

  • Acute decompensated heart failure
  • ultrafiltration
  • worsening renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Worsening renal function in patients with acute decompensated heart failure treated with ultrafiltration : Predictors and outcomes. / Raichlin, Eugenia; Haglund, Nicholas A.; Dumitru, Ioana; Lyden, Elizabeth R.; Johnston, Michael D.; Mack, Joan M.; Windle, John Robert; Lowes, Brian D.

In: Journal of Cardiac Failure, Vol. 19, No. 12, 01.12.2013, p. 787-794.

Research output: Contribution to journalArticle

Raichlin, Eugenia ; Haglund, Nicholas A. ; Dumitru, Ioana ; Lyden, Elizabeth R. ; Johnston, Michael D. ; Mack, Joan M. ; Windle, John Robert ; Lowes, Brian D. / Worsening renal function in patients with acute decompensated heart failure treated with ultrafiltration : Predictors and outcomes. In: Journal of Cardiac Failure. 2013 ; Vol. 19, No. 12. pp. 787-794.
@article{c11b7bc7e8da446d990cdf3de5372a0f,
title = "Worsening renal function in patients with acute decompensated heart failure treated with ultrafiltration: Predictors and outcomes",
abstract = "Background Ultrafiltration (UF) is used to treat patients with diuretic-resistant acute decompensated heart failure. The aim of this study was to identify predictors and the effect of worsening renal failure (WRF) on mortality in patients treated with UF. Methods and Results Based on changes in serum creatinine, 99 patients treated with UF were divided into WRF and control groups. Overall creatinine increased from 1.9 ± 9.7 to 2.2 ± 2.0 mg/dL (P <.001), and WRF developed in 41{\%} of the subjects. The peak UF rate was higher in the WRF group in univariate analysis (174 ± 45 vs 144 ± 42 mL/h; P =.03). Based on multivariate analysis, aldosterone antagonist treatment (odds ratio [OR] 3.38, 95{\%} confidence interval [CI] 1.17-13.46, P =.04), heart rate ≤65 beats/min (OR 6.03, 95{\%} CI 1.48-48.42; P =.03), and E/E′ ≥15 (OR 3.78, 95{\%} CI 1.26-17.55; P =.04) at hospital admission were associated with WRF. Patients with baseline glomerular filtration rate (GFR) ≤60 mg/dL who developed WRF during UF had a 75{\%} 1-year mortality rate. Conclusions WRF occurred frequently during UF. Increased LV filling pressures, lower heart rate, and treatment with aldosterone antagonist at hospital admission can identify patients at increased risk for WRF. Patients with baseline GFR ≤60 mg/dL and WRF during UF have an extremely high 1-year mortality rate.",
keywords = "Acute decompensated heart failure, ultrafiltration, worsening renal function",
author = "Eugenia Raichlin and Haglund, {Nicholas A.} and Ioana Dumitru and Lyden, {Elizabeth R.} and Johnston, {Michael D.} and Mack, {Joan M.} and Windle, {John Robert} and Lowes, {Brian D}",
year = "2013",
month = "12",
day = "1",
doi = "10.1016/j.cardfail.2013.10.011",
language = "English (US)",
volume = "19",
pages = "787--794",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",
number = "12",

}

TY - JOUR

T1 - Worsening renal function in patients with acute decompensated heart failure treated with ultrafiltration

T2 - Predictors and outcomes

AU - Raichlin, Eugenia

AU - Haglund, Nicholas A.

AU - Dumitru, Ioana

AU - Lyden, Elizabeth R.

AU - Johnston, Michael D.

AU - Mack, Joan M.

AU - Windle, John Robert

AU - Lowes, Brian D

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Background Ultrafiltration (UF) is used to treat patients with diuretic-resistant acute decompensated heart failure. The aim of this study was to identify predictors and the effect of worsening renal failure (WRF) on mortality in patients treated with UF. Methods and Results Based on changes in serum creatinine, 99 patients treated with UF were divided into WRF and control groups. Overall creatinine increased from 1.9 ± 9.7 to 2.2 ± 2.0 mg/dL (P <.001), and WRF developed in 41% of the subjects. The peak UF rate was higher in the WRF group in univariate analysis (174 ± 45 vs 144 ± 42 mL/h; P =.03). Based on multivariate analysis, aldosterone antagonist treatment (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.17-13.46, P =.04), heart rate ≤65 beats/min (OR 6.03, 95% CI 1.48-48.42; P =.03), and E/E′ ≥15 (OR 3.78, 95% CI 1.26-17.55; P =.04) at hospital admission were associated with WRF. Patients with baseline glomerular filtration rate (GFR) ≤60 mg/dL who developed WRF during UF had a 75% 1-year mortality rate. Conclusions WRF occurred frequently during UF. Increased LV filling pressures, lower heart rate, and treatment with aldosterone antagonist at hospital admission can identify patients at increased risk for WRF. Patients with baseline GFR ≤60 mg/dL and WRF during UF have an extremely high 1-year mortality rate.

AB - Background Ultrafiltration (UF) is used to treat patients with diuretic-resistant acute decompensated heart failure. The aim of this study was to identify predictors and the effect of worsening renal failure (WRF) on mortality in patients treated with UF. Methods and Results Based on changes in serum creatinine, 99 patients treated with UF were divided into WRF and control groups. Overall creatinine increased from 1.9 ± 9.7 to 2.2 ± 2.0 mg/dL (P <.001), and WRF developed in 41% of the subjects. The peak UF rate was higher in the WRF group in univariate analysis (174 ± 45 vs 144 ± 42 mL/h; P =.03). Based on multivariate analysis, aldosterone antagonist treatment (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.17-13.46, P =.04), heart rate ≤65 beats/min (OR 6.03, 95% CI 1.48-48.42; P =.03), and E/E′ ≥15 (OR 3.78, 95% CI 1.26-17.55; P =.04) at hospital admission were associated with WRF. Patients with baseline glomerular filtration rate (GFR) ≤60 mg/dL who developed WRF during UF had a 75% 1-year mortality rate. Conclusions WRF occurred frequently during UF. Increased LV filling pressures, lower heart rate, and treatment with aldosterone antagonist at hospital admission can identify patients at increased risk for WRF. Patients with baseline GFR ≤60 mg/dL and WRF during UF have an extremely high 1-year mortality rate.

KW - Acute decompensated heart failure

KW - ultrafiltration

KW - worsening renal function

UR - http://www.scopus.com/inward/record.url?scp=84890304473&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890304473&partnerID=8YFLogxK

U2 - 10.1016/j.cardfail.2013.10.011

DO - 10.1016/j.cardfail.2013.10.011

M3 - Article

VL - 19

SP - 787

EP - 794

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

SN - 1071-9164

IS - 12

ER -