Retrospective Analysis Of Hospitalized Chronic Heart Failure Patients With Renal Dysfunction In Recent 30 Years

Objective To analyze the incidence rate,clinical feature,drug treatment and the impact of renal dysfunction on case fatality rate of hospitalized chronic heart failure (CHF)patients in recent 30 years.Methods Applying retrospective case analysis,2555 CHF patients admitted in cardiology department of the second hospital of Tianjin Medical University from Jan 1980 to Aug 2007 were studied.Record case history,general state of health,physical examination,laboratory and ultrasound results,drug treatment and so on.Modified glomerular filtration rate(GFR)Estimating Equation for Chinese Patients was used to evaluated the patients renal function:c-aGFR(ml·min^-1·1.73m^-2)=186×[Pcr]^-1.154×[age]^-0.203×1.233(female×0.742)(Pcr:mg/dl,1mg/dl = 88.402μmol/L).According to GFR,all the patients were divided into three groups:the normal renal function group(GFR≥90ml·min^-1·1.73m^-2),the mild renal function damage group(60≤GFR＜90ml·min^-1.1.73m^-2),the renal dysfunction group(GFR＜60ml·min^-1·1.73m^-2). According to eras,all the CHF patients and CHF with renal dysfunction patients were divided into three groups:groupⅠ(1980.01-1989.12),groupⅡ(1990.01-1999.12), groupⅢ(2000.01-2007.08).Then the clinical feature and drug treatment were analyzed.The prognostic influence was analyzed by logistic regression.Results 2459 cases were enrolled,817 CHF patients'(33.3%)renal function were normal,928 CHF patients(37.7%)had mild renal function damage,714 CHF patients (29.0%)had renal dysfunction.Compared with the normal renal function group and the mild renal function damage group,the CHF with renal dysfunction patients were elder,cardiac function NYHAⅣwere more.The complication proportion of hypertension,diabetes,anaemia,hyponatremia,edema of lower extremity was higher. Left ventricular ejection fraction,blood albumn,haemoglobin,hematocrit,urine specific gravity were lower,blood urea nitrogen,blood serum creatinine,serum renin activity and concentration of angiotonin,aldosterone were higher.The application ratio of diuretic,digitalis was higher whileβ-blocker,angiotensin-converting enzyme inhibitor(ACEI)was lower(P＜0.01)).After adjustment for all other prognostic factors,renal dysfunction was an independent risk factor that increases in-hospital case fatality rate,Patients exhibited a 16.7%increase in case fatality rate for each 10 ml·min^-1·1.73m^-2decrease in GFR(OR:1.167,95%CI:1.076-1.267,P＜0.001).Renal dysfunction was an independent risk factor to case fatality rate whether the patients had left ventricular systolic dysfunction or not.Among 714 renal dysfunction cases,the median age was 72 years old.84.3% (602/714)patients were older than or equal to 60 years old and the proportion increased decade by decade(P＜0.01).There was statistical significance in the proportion of hypertension,diabetes,anaemia and cause of CHF(P＜0.01).The cause of coronary heart disease was increased while rheumatic heart disease and dilated cardiomyopathy were decreased decade by decade(P＜0.01).The major medication included nitrates(96.6%),diuretics(81.1%),digitalis(71.3%).The application proportion ofβ-blocker,statins was gradually increased decade by decade.The application of ACEI was the highest in 1990s.Hospital stay and in-hospital case fatality rate had statistical significance among different eras(P＜0.01).The hospital stay of groupⅢ,groupⅡwas shorter than groupⅠ.The in-hospital case fatality rate of groupⅢwas lower than groupⅠ,groupⅡ.Conclusion The incidence rate of renal dysfunction was higher in hospitalized CHF patients,the CHF patients with renal dysfunction were elder.The complication proportion of hypertension,diabetis,anemia,hyponatremia was more common and cardic function much worse.The higher neurohormone activity,longer hospital stay, higher in-hospital case fatality rate were also observed.Renal dysfunction was an independent risk factor to case fatality rate whether the patients had left ventricular systolic dysfunction or not.Patients exhibited a 16.7%increase in case fatality rate for each 10 ml·min^-1.1.73m^-2decrease in GFR.The drugs such as nitrates,diuretic and digitalis still dominate the major therapy for the patients.However,the application proportion of ACEI,β-blocker was lower than the guidelines.