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Renal Insufficiency Impacts Outcomes in Heart Failure

Impacts outcomes more than worsening renal function

TUESDAY, March 25 (HealthDay News) -- Baseline renal insufficiency has a bigger impact on outcomes than worsening renal function in patients with advanced decompensated heart failure, researchers report in the April 1 issue of the Journal of the American College of Cardiology.

Anju Nohria, M.D., from Harvard Medical School in Boston, and colleagues analyzed six-month outcomes in 433 patients with advanced decompensated heart failure based on renal insufficiency and worsening renal function during treatment. Patients were randomized to receive pulmonary artery catheter guidance or clinical assessment alone.

The researchers found that the risk of death or rehospitalization was higher in patients with baseline or discharge renal insufficiency. Right atrial pressure was the only hemodynamic parameter significantly associated with baseline serum creatinine in patients in the catheter group. There was no association between hemodynamic parameters and worsening renal function. Compared with clinical assessment, the catheter guidance strategy did not reduce the incidence of worsening renal function during hospitalization or after discharge.

"Among patients with advanced decompensated heart failure, baseline renal insufficiency impacts outcomes more than worsening renal function," Nohria and colleagues conclude. "Poor forward flow alone does not appear to account for the development of renal insufficiency or worsening renal function in these patients."

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