Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction

OBJECTIVES We sought to evaluate the relationship between the level of kidney function, level of hematocrit and their interaction on all-cause mortality in patients with left ventricular (LV) dysfunction. BACKGROUND Anemia and reduced kidney function occur frequently in patients with heart failure....

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2001-10, Vol.38 (4), p.955-962
Main Authors: Al-Ahmad, Amin, Rand, William M, Manjunath, Guruprasad, Konstam, Marvin A, Salem, Deeb N, Levey, Andrew S, Sarnak, Mark J
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiology. Vascular system
Double-Blind Method
Glomerular Filtration Rate
Heart
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Hematocrit
Humans
Kidney - physiopathology
Medical sciences
Multicenter Studies as Topic
Proportional Hazards Models
Randomized Controlled Trials as Topic
Retrospective Studies
Risk Factors
Ventricular Dysfunction, Left - mortality
Ventricular Dysfunction, Left - physiopathology
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Summary:OBJECTIVES We sought to evaluate the relationship between the level of kidney function, level of hematocrit and their interaction on all-cause mortality in patients with left ventricular (LV) dysfunction. BACKGROUND Anemia and reduced kidney function occur frequently in patients with heart failure. The level of hematocrit and its relationship with renal function have not been evaluated as risk factors for mortality in patients with LV dysfunction. METHODS We retrospectively examined the Studies Of LV Dysfunction (SOLVD) database. Glomerular filtration rate (GFR) was predicted using a recently validated formula. Kaplan-Meier survival analyses were used to compare survival times between groups stratified by level of kidney function (predicted GFR) and hematocrit. Cox proportional-hazards regression was used to explore the relationship of survival time to level of kidney function, hematocrit and their interaction. RESULTS Lower GFR and hematocrit were associated with a higher prevalence of traditional cardiovascular risk factors. In univariate analysis, reduced kidney function and lower hematocrit, in men and in women, were risk factors for all-cause mortality (p < 0.001 for both). After adjustment for other factors significant in univariate analysis, a 10 ml/min/1.73 m2lower GFR and a 1% lower hematocrit were associated with a 1.064 (95% CI: 1.033, 1.096) and 1.027 (95% CI: 1.015, 1.038) higher risk for mortality, respectively. At lower GFR and lower hematocrit, the risk was higher (p = 0.022 for the interaction) than that predicted by both factors independently. CONCLUSIONS Decreased kidney function and anemia are risk factors for all-cause mortality in patients with LV dysfunction, especially when both are present. These relationships need to be confirmed in additional studies.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(01)01470-X