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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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