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Circulation. 2000;102:203-210

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(Circulation. 2000;102:203.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Renal Function, Neurohormonal Activation, and Survival in Patients With Chronic Heart Failure

Hans L. Hillege, MD; Armand R. J. Girbes, MD; Pieter J. de Kam, MSc; Frans Boomsma, PhD; Dick de Zeeuw, MD; Andrew Charlesworth, MSc; John R. Hampton, MD; Dirk J. van Veldhuisen, MD

From the Department of Clinical Pharmacology, State University Groningen, The Netherlands (H.L.H, D.d.Z.); the Department of Intensive Care, University Hospital of Free University, Amsterdam, The Netherlands (A.R.J.G.); the Department of Cardiology/Thoraxcenter, University Hospital Groningen, The Netherlands (P.J.d.K, D.J.v.V.); COEUR/Department of Internal Medicine, University Hospital Dijkzigt, Rotterdam, The Netherlands (F.B.); Nottingham Clinical Trial Data Centre, Nottingham, United Kingdom (A.C.); and Department of Cardiovascular Medicine, Queen’s Medical Centre, Nottingham, United Kingdom (J.R.H.).

Correspondence to Dr D.J. van Veldhuisen, Department of Cardiology/Thoraxcenter, University Hospital Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands. E-mail d.j.van.veldhuisen{at}thorax.azg.nl

Background—Because renal function is affected by chronic heart failure (CHF) and it relates to both cardiovascular and hemodynamic properties, it should have additional prognostic value. We studied whether renal function is a predictor for mortality in advanced CHF, and we assessed its relative contribution compared with other established risk factors. In addition, we studied the relation between renal function and neurohormonal activation.

Methods and Results—The study population consisted of 1906 patients with CHF who were enrolled in a recent survival trial (Second Prospective Randomized study of Ibopamine on Mortality and Efficacy). In a subgroup of 372 patients, plasma neurohormones were determined. The baseline glomerular filtration rate (GFRc) was calculated using the Cockroft Gault equation. GFRc was the most powerful predictor of mortality; it was followed by New York Heart Association functional class and the use of angiotensin-converting enzyme inhibitors. Patients in the lowest quartile of GFRc values (<44 mL/min) had almost 3 times the risk of mortality (relative risk, 2.85; P<0.001) of patients in the highest quartile (>76 mL/min). Impaired left ventricular ejection fraction (LVEF) was only modestly predictive (P=0.053). GFRc was inversely related with N-terminal atrial natriuretic peptide (ANP; r=-0.53) and, to a lesser extent, with ANP itself (r=-0.35; both P<0.001).

Conclusions—Impaired renal function (GFRc) is a stronger predictor of mortality than impaired cardiac function (LVEF and New York Heart Association class) in advanced CHF, and it is associated with increased levels of N-terminal ANP. Moreover, impaired renal function was not related to LVEF, which suggests that factors other than reduced cardiac output are causally involved.


Key Words: heart failure • prognosis • kidney • hormones




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