Background
Methods
Study population
Clinical scenario
Procedures
Definitions
Statistical analyses
Results
Patient characteristics
Prevalence and clinical correlates of WRF
Baseline characteristics | Total (n = 245) | ||
---|---|---|---|
WRF | |||
Yes (n = 36) | No (n = 209) | ||
Age, yrs | 82.9 ± 6.0 | 82.3 ± 6.4 | 83.1 ± 6.0 |
Male, % | 49.4 | 41.7 | 50.7 |
Body weight at assessment, kg | 50.1 ± 12.0 | 48.4 ± 14.3 | 50.5 ± 11.5 |
Clinical scenario 1, % | 41.2 | 58.3* | 38.3 |
Clinical scenario 2, % | 30.6 | 16.7* | 33.0 |
Clinical scenario 3, % | 8.2 | 8.3 | 8.1 |
Clinical scenario 4, % | 13.1 | 13.9 | 12.4 |
Ejection fraction, % | 45.6 ± 14.7 | 42.5 ± 13.0 | 46.2 ± 14.9 |
Current smoking, % | 25.3 | 27.8 | 24.9 |
Daily alcohol intake, % | 20.4 | 11.1 | 22.0 |
Hypertension, % | 78.3 | 91.7* | 76.0 |
Diabetes mellitus, % | 33.9 | 33.3 | 34.0 |
Lipid disorder, % | 44.4 | 44.4 | 38.8 |
Chronic atrial fibrillation, % | 23.6 | 22.2 | 23.9 |
Baseline laboratory values: | |||
Log BNP | 6.07 ± 1.2 | 6.38 ± 0.9 | 6.01 ± 1.2 |
Hemoglobin, g/dL | 11.8 ± 2.1 | 11.7 ± 2.2 | 11.8 ± 2.1 |
BUN, mg/dL | 31.5 ± 17.3 | 30.7 ± 16.5 | 31.6 ± 17.5 |
Serum creatinine, g/dL | 1.50 ± 1.0 | 1.61 ± 1.0 | 1.47 ± 1.0 |
Medication at baseline: | |||
ACEI use, % | 8.17 | 2.78 | 9.1 |
ARB use, % | 45.3 | 52.8 | 44.0 |
CCB use, % | 40.0 | 36.1 | 40.7 |
Beta-blocker, % | 29.0 | 36.1 | 27.8 |
Loop diuretics, % | 50.0 | 58.3 | 48.6 |
Medication during admission: | |||
I.V. loop diuretic use, % | 75.5 | 88.9* | 73.2 |
I.V. isosorbide dinitrate, % | 27.8 | 50.0** | 23.9 |
I.V. carperitide use, % | 7.8 | 5.6 | 8.1 |
Blood pressure and heart rate parameters: | |||
Systolic blood pressure admission, mmHg | 140 ± 32 | 158 ± 37*** | 137 ± 30 |
Diastolic blood pressure at admission, mmHg | 76.5 ± 19 | 78.5 ± 18 | 76.1 ± 20 |
Heart rate at admission, mmHg | 88.1 ± 28 | 79.3 ± 21* | 89.6 ± 29 |
Early systolic blood pressure drop, mmHg | 35.3 ± 31 | 51.3 ± 30*** | 32.5 ± 30 |
Factors associated with worsening renal function on univariate analysis
Baseline characteristics | Odds ratio | 95% CI | p-value |
---|---|---|---|
Age, yrs | 0.98 | 0.92–1.04 | 0.5 |
Male, yes = 1, no = 0 | 0.69 | 0.34–1.42 | 0.3 |
Body weight at assessment, kg | 0.99 | 0.96–1.02 | 0.4 |
Clinical scenario 1, yes = 1, no = 0 | 1.42 | 0.64–3.18 | 0.4 |
Clinical scenario 2, yes = 1, no = 0 | 1 (Ref.) | – | – |
Clinical scenario 3, yes = 1, no = 0 | 1.04 | 0.27–3.99 | 0.96 |
Clinical scenario 4, yes = 1, no = 0 | 1.33 | 0.43–4.08 | 0.6 |
Ejection fraction, % | 0.18 | 0.96–1.01 | 0.2 |
Current smoking, yes = 1, no = 0 | 1.16 | 0.53–2.57 | 0.7 |
Daily alcohol intake, yes = 1, no = 0 | 0.14 | 0.15–1.32 | 0.1 |
Hypertension, yes = 1, no = 0 | 3.48 | 1.02–11.8 | 0.046 |
Diabetes mellitus, yes = 1, no = 0 | 0.97 | 0.46–2.06 | 0.9 |
Lipid disorder, yes = 1, no = 0 | 1.23 | 0.62–2.58 | 0.5 |
Chronic atrial fibrillation, yes = 1, no = 0 | 0.91 | 0.39–2.12 | 0.8 |
Baseline laboratory values: | |||
Log BNP | 1.36 | 0.97–1.91 | 0.08 |
Hemoglobin, g/dL | 0.97 | 0.82–1.15 | 0.7 |
BUN, mg/dL | 0.997 | 0.98–1.02 | 0.8 |
Serum creatinine, g/dL | 1.12 | 0.83–1.53 | 0.5 |
Medication at baseline: | |||
ACEI use, yes = 1, no = 0 | 0.29 | 0.04–2.20 | 0.2 |
ARB use, yes = 1, no = 0 | 1.42 | 0.70–2.89 | 0.3 |
CCB use, yes = 1, no = 0 | 0.83 | 0.40–1.72 | 0.6 |
Beta-blocker, yes = 1, no = 0 | 1.47 | 0.70–3.01 | 0.3 |
Loop diuretics, yes = 1, no = 0 | 1.48 | 0.73–3.04 | 0.3 |
Medication during admission | |||
I.V. loop diuretic use, yes = 1, no = 0 | 2.93 | 0.99–8.65 | 0.052 |
I.V. isosorbide dinitrate, yes = 1, no = 0 | 3.18 | 1.54–6.58 | 0.002 |
I.V. carperitide use, yes = 1, no = 0 | 0.66 | 0.15–3.01 | 0.6 |
Blood pressure and heart rate parameters | |||
Systolic blood pressure at admission, mmHg | 1.02 | 1.01–1.03 | 0.001 |
Diastolic blood pressure at admission, mmHg | 1.01 | 0.99–1.03 | 0.5 |
Heart rate at admission, mmHg | 0.987 | 0.97–0.999 | 0.046 |
Early systolic blood pressure drop, mmHg | 1.02 | 1.01–1.03 | 0.001 |
Determinants of WRF
Trait | Adjusted odds ratio | 95% CI | p-value |
---|---|---|---|
Age, yrs | 0.95 | 0.88–1.02 | 0.13 |
Male, yes = 1, no = 0 | 0.54 | 0.22–1.33 | 0.18 |
Ejection fraction, % | 0.97 | 0.94–1.01 | 0.09 |
Hypertension, yes = 1, no = 0 | 2.93 | 0.77–11.1 | 0.12 |
Beta-blocker at baseline, yes = 1, no = 0 | 1.44 | 0.60–3.44 | 0.41 |
Log BNP | 1.05 | 0.65–1.70 | 0.85 |
I.V. loop diuretic use during admission, yes = 1, no = 0 | 2.21 | 0.58–8.35 | 0.24 |
I.V. isosorbide dinitrate during admission, yes = 1, no = 0 | 1.80 | 0.73–4.48 | 0.20 |
I.V. carperitide use during admission, yes = 1, no = 0 | 0.68 | 0.13–3.57 | 0.65 |
Heart rate at admission, bpm | 0.98 | 0.96–0.99 | 0.004 |
Early systolic blood pressure drop, mmHg | 1.02 | 1.004–1.03 | 0.02 |