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J Am Coll Cardiol, 2001; 38:955-962
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY

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

Amin Al-Ahmad, MD*, William M. Rand, PhD{dagger}, Guruprasad Manjunath, MD{ddagger}, Marvin A. Konstam, MD*, Deeb N. Salem, MD*, Andrew S. Levey, MD{ddagger} and Mark J. Sarnak, MD{ddagger}

* Division of Cardiology, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
{dagger} Department of Community Health, Tufts University School of Medicine, Boston, Massachusetts, USA
{ddagger} Division of Nephrology, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA

Manuscript received February 23, 2001; revised manuscript received May 21, 2001, accepted June 11, 2001.

Reprint requests and correspondence: Dr. Mark J. Sarnak, New England Medical Center, Box 391, 750 Washington Street, Boston, Massachusetts 02111
msarnak{at}lifespan.org

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 m2 lower 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.

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  ESRD = end-stage renal disease
  GFR = glomerular filtration rate
  HF = heart failure
  LV = left ventricle or left ventricular
  MDRD = Modification of Diet in Renal Disease
  NYHA = New York Heart Association
  SOLVD = Studies Of Left Ventricular Dysfunction




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Circulation, September 5, 2006; 114(10): 1083 - 1087.
[Abstract] [Full Text] [PDF]

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J. E. W. Hertel, H. R. Locay, D. S. Scarlata, R. Prathikanti, and P. K. Audhya
Darbepoetin Alfa Administration to Achieve and Maintain Target Hemoglobin Levels for 1 Year in Patients With Chronic Kidney Disease
Mayo Clin. Proc., September 1, 2006; 81(9): 1188 - 1194.
[Abstract] [Full Text] [PDF]

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 J. Am. Soc. Nephrol.Home page
A. M. Walker, G. Schneider, J. Yeaw, B. Nordstrom, S. Robbins, and D. Pettitt
Anemia as a Predictor of Cardiovascular Events in Patients with Elevated Serum Creatinine
J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2293 - 2298.
[Abstract] [Full Text] [PDF]

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 CJASNHome page
W. F. Keane, Z. Zhang, P. A. Lyle, M. E. Cooper, D. de Zeeuw, J.-P. Grunfeld, J. P. Lash, J. B. McGill, W. E. Mitch, G. Remuzzi, et al.
Risk Scores for Predicting Outcomes in Patients with Type 2 Diabetes and Nephropathy: The RENAAL Study
Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 761 - 767.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
A. S. Go, J. Yang, L. M. Ackerson, K. Lepper, S. Robbins, B. M. Massie, and M. G. Shlipak
Hemoglobin Level, Chronic Kidney Disease, and the Risks of Death and Hospitalization in Adults With Chronic Heart Failure: The Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study
Circulation, June 13, 2006; 113(23): 2713 - 2723.
[Abstract] [Full Text] [PDF]

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 HeartHome page
L Grigorian Shamagian, A Varela Roman, J M Garcia-Acuna, P Mazon Ramos, A Virgos Lamela, and J R Gonzalez-Juanatey
Anaemia is associated with higher mortality among patients with heart failure with preserved systolic function
Heart, June 1, 2006; 92(6): 780 - 784.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
Y.-D. Tang and S. D. Katz
Anemia in Chronic Heart Failure: Prevalence, Etiology, Clinical Correlates, and Treatment Options
Circulation, May 23, 2006; 113(20): 2454 - 2461.
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 Arch Intern MedHome page
G. L. Smith, M. G. Shlipak, E. P. Havranek, J. M. Foody, F. A. Masoudi, S. S. Rathore, and H. M. Krumholz
Serum urea nitrogen, creatinine, and estimators of renal function: mortality in older patients with cardiovascular disease.
Arch Intern Med, May 22, 2006; 166(10): 1134 - 1142.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
G. L. Smith, J. H. Lichtman, M. B. Bracken, M. G. Shlipak, C. O. Phillips, P. DiCapua, and H. M. Krumholz
Renal Impairment and Outcomes in Heart Failure: Systematic Review and Meta-Analysis
J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1987 - 1996.
[Abstract] [Full Text] [PDF]

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 BloodHome page
B. F. Culleton, B. J. Manns, J. Zhang, M. Tonelli, S. Klarenbach, and B. R. Hemmelgarn
Impact of anemia on hospitalization and mortality in older adults
Blood, May 15, 2006; 107(10): 3841 - 3846.
[Abstract] [Full Text] [PDF]

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A. Ishani, G. A. Grandits, R. H. Grimm, K. H. Svendsen, A. J. Collins, R. J. Prineas, J. D. Neaton, and for the MRFIT Research Group
Association of Single Measurements of Dipstick Proteinuria, Estimated Glomerular Filtration Rate, and Hematocrit with 25-Year Incidence of End-Stage Renal Disease in the Multiple Risk Factor Intervention Trial
J. Am. Soc. Nephrol., May 1, 2006; 17(5): 1444 - 1452.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
E. O'Meara, T. Clayton, M. B. McEntegart, J. J.V. McMurray, C. C. Lang, S. D. Roger, J. B. Young, S. D. Solomon, C. B. Granger, J. Ostergren, et al.
Clinical Correlates and Consequences of Anemia in a Broad Spectrum of Patients With Heart Failure: Results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program
Circulation, February 21, 2006; 113(7): 986 - 994.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
H. L. Hillege, D. Nitsch, M. A. Pfeffer, K. Swedberg, J. J.V. McMurray, S. Yusuf, C. B. Granger, E. L. Michelson, J. Ostergren, J. H. Cornel, et al.
Renal Function as a Predictor of Outcome in a Broad Spectrum of Patients With Heart Failure
Circulation, February 7, 2006; 113(5): 671 - 678.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
C. W. Yancy, M. Lopatin, L. W. Stevenson, T. De Marco, G. C. Fonarow, and for the ADHERE Scientific Advisory Committee and I
Clinical Presentation, Management, and In-Hospital Outcomes of Patients Admitted With Acute Decompensated Heart Failure With Preserved Systolic Function: A Report From the Acute Decompensated Heart Failure National Registry (ADHERE) Database
J. Am. Coll. Cardiol., January 3, 2006; 47(1): 76 - 84.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
S. J. Pocock, D. Wang, M. A. Pfeffer, S. Yusuf, J. J.V. McMurray, K. B. Swedberg, J. Ostergren, E. L. Michelson, K. S. Pieper, C. B. Granger, et al.
Predictors of mortality and morbidity in patients with chronic heart failure
Eur. Heart J., January 1, 2006; 27(1): 65 - 75.
[Abstract] [Full Text] [PDF]

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 Eur J Heart FailHome page
G. M. Felker, W. G. Stough, L. K. Shaw, and C. M. O'Connor
Anaemia and coronary artery disease severity in patients with heart failure
Eur J Heart Fail, January 1, 2006; 8(1): 54 - 57.
[Abstract] [Full Text] [PDF]

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 Eur J Heart FailHome page
E. O'Meara, K. S. Chong, R. S. Gardner, A. G. Jardine, J. B. Neilly, and T. A. McDonagh
The Modification of Diet in Renal Disease (MDRD) equations provide valid estimations of glomerular filtration rates in patients with advanced heart failure
Eur J Heart Fail, January 1, 2006; 8(1): 63 - 67.
[Abstract] [Full Text] [PDF]

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N. A. Khan, I. Ma, C. R. Thompson, K. Humphries, D. N. Salem, M. J. Sarnak, and A. Levin
Kidney Function and Mortality among Patients with Left Ventricular Systolic Dysfunction
J. Am. Soc. Nephrol., January 1, 2006; 17(1): 244 - 253.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
M. A. Konstam, B. Czerska, M. Bohm, R. M. Oren, J. Sadowski, S. Khanal, W. T. Abraham, A. Wasler, J. B. Dahm, A. Gavazzi, et al.
Continuous Aortic Flow Augmentation: A Pilot Study of Hemodynamic and Renal Responses to a Novel Percutaneous Intervention in Decompensated Heart Failure
Circulation, November 15, 2005; 112(20): 3107 - 3114.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
J.-P. Collet, G. Montalescot, G. Agnelli, F. Van de Werf, E. P. Gurfinkel, J. Lopez-Sendon, C. V. Laufenberg, M. Klutman, N. Gowda, D. Gulba, et al.
Non-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events
Eur. Heart J., November 1, 2005; 26(21): 2285 - 2293.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
C. Opasich, M. Cazzola, L. Scelsi, S. De Feo, E. Bosimini, R. Lagioia, O. Febo, R. Ferrari, A. Fucili, R. Moratti, et al.
Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure
Eur. Heart J., November 1, 2005; 26(21): 2232 - 2237.
[Abstract] [Full Text] [PDF]


 
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