Prognosis in patients with congestive heart failure and subacute renal failure treated with hemodialysis

Abstract

Renal dysfunction confers a grave prognosis for patients with congestive heart failure (CHF); even small increases in plasma creatinine are associated with excess mortality. Little, however, is known about prognostic indices and outcome in patients with CHF who (sub-)acutely progress to dialysis dependency. We evaluated prognostic indices in a retrospective cohort analysis of non-critically ill patients with CHF who (sub-)acutely progressed to dialysis-dependent renal failure. 46 patients (95% ischemic cardiomyopathy) with CHF (NYHA III-IV) with dialysis-dependent renal failure (acute and acute-to-chronic renal failure) were analyzed. Demographic factors and patient characteristics, of cardiac function parameters and renal parameters were recorded longitudinally. CHF patients progressing to dialysis- dependent renal failure had a grave prognosis: median survival time was 95 days, mean survival 444 days. None of the known factors except age was associated with a worse outcome in CHF patients. LV/RV dysfunction, high plasma NT-pro-BNP, C-reactive protein, low albumin and body-mass index did not turn out to be prognostic indicators. The only factors indicating improved survival were recovery of renal function and low hemoglobin. Non-critically ill CHF patients with (sub-)acute renal dysfunction progressing to dialysis dependency have a grave prognosis. Renal failure itself had such a strong prognostic impact that conventional factors such as poor myocardial function or inflammation were concealed. Recovery of renal function and, surprisingly, anemia were beneficial factors. Alternative treatment strategies must be designed to improve the devastating prognosis for this special subset of patients with CHF.