Objectives: We estimated the prevalence of renal impairment in heart failure(HF) patients and the magnitude of associated mortality risk using a systematic review of published studies. Background: Renal impairment in HF patients is associated with excess mortality, although precise risk estimates are unclear. Methods: A systematic search of MEDLINE(through May 2005) identified 16 studies characterizing the association between renal impairment and mortality in 80,098 hospitalized and non-hospitalized HF patients. All-cause mortality risks associated with any renal impairment(creatinine >1.0 mg/dl, creatinine clearance[CrCl] or estimated glomerular filtration rate[eGFR]1.03 mg/dl) and moderate to severe impairment(creatinine ≥1.5, CrCl or eGFR< 53, or cystatin-C ≥1.56) were estimated using fixed-effects meta-analysis. Results: A total of 63%of patients had any renal impairment, and 29%had moderate to severe impairment. After follow-up ≥1 year, 38%of patients with any renal impairment and 51%with moderate to severe impairment died versus 24%without impairment. Adjusted all-cause mortality was increased for patients with any impairment(hazard ratio[HR]=1.56; 95%confidence interval[CI] 1.53 to 1.60, p< 0.001) and moderate to severe impairment(HR=2.31; 95%CI 2.18 to 2.44, p< 0.001). Mortality worsened incrementally across the range of renal function, with 15%(95%CI 14%to 17%) increased risk for every 0.5 mg/dl increase in creatinine and 7%(95%CI 4%to 10%) increased risk for every 10 ml/min decrease in eGFR. Conclusions: Renal impairment is common among HF patients and confers excess mortality. Renal function should be considered in risk stratification and evaluation of therapeutic strategies for HF patients.
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