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European Heart Journal
Amsalem, Y., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Garty, M., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Schwartz, R., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Sandach, A., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Behar, S., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Caspi, A., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Gottlieb, S., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Ezra, D., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Lewis, B.S., Lady Davis Carmel Medical Center, Bruce Rappaport School of Medicine, Haifa, Israel
Leor, J., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Aims: Renal insufficiency (RI) is a strong predictor of adverse outcome in patients with heart failure (HF). We aimed to determine the prevalence of RI being unrecognized and its significance in patients hospitalized with HF. Methods and results: We analysed data from a prospective survey of 4102 hospitalized patients with HF. RI [defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] was present in 2145 (57%) patients but, based on medical records, was unrecognized in 872 [41%, 95% confidence interval (CI) 39-43%] of them. Patients with unrecognized RI were more likely to be women, elderly, and with better functional class, compared with patients with recognized RI. In-hospital and 1 year mortality was significantly higher among patients with recognized and unrecognized RI compared with patients without RI: 6.5 and 7.1 vs. 2.1%, and 38.8 and 30.9 vs. 18.8% (P < 0.001), respectively. After adjustment, recognized and unrecognized RI comparably predicted increased in-hospital mortality: odds ratio (OR) and 95% CI of 2.34 (1.43-3.87), P < 0.001, and 2.30 (1.45-3.72), P < 0.001. After 1 year, recognized RI remained an independent predictor for mortality: OR 1.79 (1.45-2.20), P < 0.001, whereas there was a trend for increased mortality predicted by unrecognized RI: OR 1.22 (0.97-1.53), P = 0.08.ConclusionA high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR. © The Author 2008.
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הספר "אוצר וולקני"
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תנאי שימוש
Prevalence and significance of unrecognized renal insufficiency in patients with heart failure
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Amsalem, Y., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Garty, M., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Schwartz, R., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Sandach, A., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Behar, S., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Caspi, A., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Gottlieb, S., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Ezra, D., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Lewis, B.S., Lady Davis Carmel Medical Center, Bruce Rappaport School of Medicine, Haifa, Israel
Leor, J., Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
Prevalence and significance of unrecognized renal insufficiency in patients with heart failure
Aims: Renal insufficiency (RI) is a strong predictor of adverse outcome in patients with heart failure (HF). We aimed to determine the prevalence of RI being unrecognized and its significance in patients hospitalized with HF. Methods and results: We analysed data from a prospective survey of 4102 hospitalized patients with HF. RI [defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] was present in 2145 (57%) patients but, based on medical records, was unrecognized in 872 [41%, 95% confidence interval (CI) 39-43%] of them. Patients with unrecognized RI were more likely to be women, elderly, and with better functional class, compared with patients with recognized RI. In-hospital and 1 year mortality was significantly higher among patients with recognized and unrecognized RI compared with patients without RI: 6.5 and 7.1 vs. 2.1%, and 38.8 and 30.9 vs. 18.8% (P < 0.001), respectively. After adjustment, recognized and unrecognized RI comparably predicted increased in-hospital mortality: odds ratio (OR) and 95% CI of 2.34 (1.43-3.87), P < 0.001, and 2.30 (1.45-3.72), P < 0.001. After 1 year, recognized RI remained an independent predictor for mortality: OR 1.79 (1.45-2.20), P < 0.001, whereas there was a trend for increased mortality predicted by unrecognized RI: OR 1.22 (0.97-1.53), P = 0.08.ConclusionA high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR. © The Author 2008.
Scientific Publication
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