Predictors of decreased renal function in patients with heart failure during angiotensin-converting enzyme inhibitor therapy: Results from the Studies of Left Ventricular Dysfunction (SOLVD)☆,☆☆,★
Section snippets
Methods
The Studies of Left Ventricular Dysfunction (SOLVD) database was used to investigate specific clinical characteristics related to the development of decreased renal function in patients treated with enalapril for CHF.27 The SOLVD study was a randomized, double-blind, placebo-controlled trial of enalapril for the treatment of CHF. The combined treatment and prevention trials used in this study included 6797 patients who were initially selected based on hospitalization discharge diagnosis and
Results
During a mean follow-up of 779 days, 515 (16%) of 3246 patients in the enalapril group had decreased renal function develop according to the study definition compared with 385 (12%) of 3269 in the placebo group during a mean follow-up of 751 days. Baseline clinical predictors for both groups are presented in Table I.Variable Placebo group Enalapril group P value Baseline creatinine (mg/dL) 1.2 ± 0.3* 1.2 ± 0.3* .48 Baseline ejection fraction (%) 27 ± 6
Discussion
Analysis of data from this large randomized, controlled trial of ACE inhibitor use in CHF reveals important new information about clinical predictors of renal insufficiency in patients with CHF. Although some risk factors for decreased renal function, such as age, were expected, we were able to quantify this risk and demonstrate that the enalapril-induced risk of renal impairment increases with advanced age. We also found that enalapril increased the risk of diuretic-associated renal impairment
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Supported by The Medical Foundation Postdoctoral Fellowship Program in Clinical and Community Health Research.
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Reprint requests: Eric Knight, MD, MPH, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, 221 Longwood Ave, third floor, Boston, MA 02115.
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0002-8703/99/$8.00 + 0 4/1/101106