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Impact of worsening renal function related to medication in heart failure
Author(s) -
BrunnerLa Rocca HansPeter,
Knackstedt Christian,
Eurlings Luc,
Rolny Vinzent,
Krause Friedemann,
Pfisterer Matthias E.,
Tobler Daniel,
Rickenbacher Peter,
Maeder Micha T.
Publication year - 2015
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.210
Subject(s) - spironolactone , medicine , heart failure , loop diuretic , renal function , diuretic , cardiology , creatinine
Aims Renal failure is a major challenge in treating heart failure ( HF ) patients. HF medication may deteriorate renal function, but the impact thereof on outcome is unknown. We investigated the effects of HF medication on worsening renal function ( WRF ) and the relationship to outcome. Methods and results This post‐hoc analysis of TIME‐CHF ( NT‐proBNP ‐guided vs. symptom‐guided management in chronic HF ) included patients with LVEF ≤45% and ≥1 follow‐up visit ( n = 462). WRF III was defined as a rise in serum creatinine ≥0.5 mg/ dL (i.e. 44.2 µmol/L) at any time during the first 6 months. Four classes of medication were considered: loop diuretics, beta‐blockers, renin–angiotensin system ( RAS )‐blockers, and spironolactone. Functional principal component analysis of daily doses was used to comprehend medication over time. All‐cause mortality after 18 months was the primary outcome. Interactions between WRF , medication, and outcome were tested. Patients with WRF III received on average higher loop diuretic doses ( P = 0.0002) and more spironolactone ( P = 0.02), whereas beta‐blockers ( P = 0.69) did not differ and lower doses of RAS ‐blockers were given ( P = 0.09). There were significant interactions between WRF III , medicationn and outcome. Thus, WRF III was associated with poor prognosis if high loop diuretic doses were given ( P = 0.001), but not with low doses ( P = 0.29). The opposite was found for spironolactone (poor prognosis in the case of WRF III with no spironolactone, P <0.0001; but not with spironolactone, P = 0.31). Beta‐blockers were protective in all patients ( P <0.001), but most in those with WRF III ( P <0.05 for interaction). RAS ‐blockade was associated with improved outcome ( P = 0.006), irrespective of WRF III . Conclusion Based on this analysis, it may be hypothesized that high doses of loop diuretics might have detrimental effects, particularly in combination with significant WRF , whereas spironolactone and beta‐blockers might be protective in patients with WRF .