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The impact of kidney dysfunction categorized by urinary to serum creatinine ratio on clinical outcomes in patients with heart failure

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Abstract

Kidney dysfunction (KD) is closely associated with poor clinical outcome in patients with heart failure (HF). KD is classified as intrinsic and pre-renal KD. However, the impact of each KD on the clinical outcome in patients with HF has not yet been fully elucidated. We measured the urinary to serum creatinine (UC/SC) ratio, a marker for intrinsic and pre-renal KD, in 1009 consecutive patients with HF at admission. There were 314 cardio-renal events including HF and advanced end-stage renal dysfunction during the median follow-up period of 1154 days. There were 63 (6%) patients with intrinsic KD (UC/SC ratio < 20), 118 (12%) patients with intermediate KD (UC/SC ratio 20–40), 607 (60%) patients with pre-renal KD (UC/SC ratio > 40), and 221 (22%) patients with no KD. Multivariate Cox’s proportional hazard regression analysis demonstrated that intrinsic and intermediate KDs were significantly associated with poor clinical outcome. The prediction model for cardio-renal events was significantly improved by the addition of UC/SC ratio to the confounding risk factors. Subgroup analysis in patients with HF with severely reduced glomerular filtration rates showed that the prevalence rates of intrinsic, intermediate, and pre-renal KDs were 23%, 30%, and 47%, respectively. The cardio-renal event rate was the highest in the intrinsic KD group compared with that in the other groups. Intrinsic KD was closely associated with extremely poor clinical outcome in patients with HF. The UC/SC ratio could provide important clinical information for the treatment and management of KD in patients with HF.

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Acknowledgements

This study was supported, in part, by a Grant-in-aid for Scientific Research (nos. 16K09490 and 18K15838) from the Ministry of Education Culture, Sport, Science, and Technology.

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Authors and Affiliations

  1. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Yoichiro Otaki, Tetsu Watanabe, Harutoshi Tamura, Shigehiko Kato, Satoshi Nishiyama, Hiroki Takahashi, Takanori Arimoto, Tetsuro Shishido & Masafumi Watanabe

  2. Department of Public Health and Hygiene, Yamagata University School of Medicine, Yamagata, Japan

    Tsuneo Konta

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  1. Yoichiro Otaki
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  2. Tetsu Watanabe
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Correspondence to Tetsu Watanabe.

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380_2019_1472_MOESM1_ESM.tif

The association of KD category with clinical outcomes such as heart failure re-hospitalization, ESRD, cardiac deaths, and all-cause deaths. KD, kidney dysfunction. ESRD, end-stage renal disease. (TIFF 132 kb)

380_2019_1472_MOESM2_ESM.tif

Receiver operating characteristic curve of urinary to serum creatinine ratio, urinary creatinine and serum creatinine for cardio-renal events in patients with advanced chronic kidney disease. (TIFF 92 kb)

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Otaki, Y., Watanabe, T., Konta, T. et al. The impact of kidney dysfunction categorized by urinary to serum creatinine ratio on clinical outcomes in patients with heart failure. Heart Vessels 35, 187–196 (2020). https://doi.org/10.1007/s00380-019-01472-4

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  • DOI: https://doi.org/10.1007/s00380-019-01472-4

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