Systolic and diastolic heart failure and renal dysfunction in hospitalized elderly patients

Objective. Heart failure (HF) is a syndrome characterized by symptoms such as dyspnoea and fatigue and objective evidence of cardiac systolic and/or diastolic dysfunction. HF occurs predominantly among older subjects and it is associated with poor prognosis. Coexistence of renal impairment with HF with preserved or depressed ejection fraction is common. Unfortunately there are no fully validated equations estimating kidney function in the elderly. Aims of our study were to evaluate prevalence of systolic and diastolic HF among elderly inpatients and to define the relation between HF and impairment of glomerular filtration rate (GFR) estimated from three formulas.Methods. We enrolled 165 elderly patients (72 men and 93 women, mean age: 80 ± 7 years), consecutively hospitalized at Cardiology Unit of our Institute in a cross-sectional analysis. All patients had complete clinical examination, ECG and laboratory tests. All subjects underwent standard echocardiographic examination. HF was defined according Heart Failure Society of America Criteria. GFR was estimated from three formulas: the Modification in Diet and Renal Disease (MDRD) formula, CKD-EPI equation and Cockroft-Gault formula adjusted for body surface area (CG-BSA).Results. Prevalence of HF among patients was 67.3%. Prevalences of diastolic HF and systolic HF were 38.2% and 29.1% respectively. Diastolic HF patients included a significantly higher proportion of women (p: 0.023 by Chi-Square) and subjects with age ≥ 80 years (p: 0.018 by Chi-Square). Systolic HF patients had more frequently history of diabetes mellitus (p: 0.018 by Chi-Square) and ischemic heart disease (p: 0.000 by Chi-Square). GFR estimations from three formulas showed a reducing trend from subjects without HF to diastolic and systolic HF patients (p: 0.000 for CKD-EPI; p: 0.000 for MDRD; p: 0.023 for CG-BSA by one-way ANOVA). On logistic regression analysis, the risk of moderate renal dysfunction (defined as GFR < 60 mL/min/1.73 m2) was higher in HF patients: OR 1.97 (95% CI, 1.22 to 3.17) when GFR was estimated from CKD-EPI formula; OR 1.75; (95% CI, 1.11 to 2.77) when GFR was estimated from MDRD formula.Conclusions. In our cohort of hospitalized old subjects, the majority of individuals with HF had preserved left ventricular ejection fraction. Reduction of GFR is highly prevalent in elderly inpatients with HF. Because of the association between HF and renal dysfunction, old patients with systolic and diastolic HF should be regularly evaluated for chronic kidney disease. Which is the most accurate equation for estimation of their GFR still needs to be investigated.