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Research purpose: in-depth study to explore elderly patients with chronic heart failure complicated by renal insufficiency, the incidence and clinical characteristics of the patients, and analysis assessment renal insufficiency hospital mortality of elderly patients with chronic heart failure, 2 years after the onset of mortality and again heart failure hospitalization rates and other prognostic impact. Materials and Methods: A retrospective case collection way to select the People's Liberation Army General Hospital first time a total of 291 cases of hospitalized elderly patients with chronic heart failure in October 2005 - October. Collected clinical characteristics of the patients first admission, including: general information, etiology, comorbidities, clinical manifestations, therapy and laboratory markers, echocardiography results. Calculated using the simplified MDRD formula in our improved according to patient admission serum creatinine in patients with estimated glomerular filtration rate (eGFR): eGFR (ml.min-1.1.73m-2) = 186 × [Cr] -1.154 x [Age-0.203x1.233 (female × 0.742) the formula Cr units mg / dl (1mg/dl = 88.4μmol / L). According to the calculated results of eGFR, the selected 253 patients divided into three groups: normal renal function group (in eGFR of ≥ 90 ml.min-1.1.73m-2), mild renal impairment (60 ≤ eGFR lt; 90ml.min-1.1.73m-2), renal insufficiency (eGFR lt; 60ml.min-1.1.73m-2). Admission general, etiology, comorbidities, clinical symptoms, laboratory results, ultrasound and echocardiography results, medication such as clinical features of renal packet analysis three groups of patients with chronic heart failure. The primary endpoint of the study for the first time during hospitalization and after discharge die within two years of the research, to re-hospitalization for heart failure, recurrent coronary events, malignant arrhythmia, stroke as a secondary endpoint of the study. The analysis study three groups of patients with renal packet hospital mortality for the first time and 2 years after the onset of mortality, re-hospitalization for heart failure rate and recurrence of coronary events, malignant arrhythmias, the incidence of stroke outcome. Logistic regression analysis of independent risk factors affect elderly patients with chronic heart failure in patients with mortality and re-admission rate. Results: A total of 253 cases for the first time in hospitalized elderly patients with chronic heart failure, the median age was 78 years. Were male and 168 (66.4%), female 85 cases (33.6%). Heart function classified as grade Ⅱ - Ⅳ center function Ⅱ 123 cases (48.6%), cardiac function Ⅲ 83 cases (32.8%), NYHA Ⅳ 47 cases (18.6%). 106 cases (41.9%) with normal renal function, mild renal impairment admission in 87 cases (34.4%), renal insufficiency in 60 patients (23.7%). Renal insufficiency group with normal renal function, mild renal impairment compared renal insufficiency older, lower proportion of cardiac function Ⅱ, a higher proportion of NYHA Ⅳ, combined with high blood pressure, old myocardial infarction, acute myocardial infarction, diabetes, lung infections, anemia proportion of paroxysmal nocturnal dyspnea, exertional dyspnea, lung bottom rales, acute pulmonary edema, lower limb edema, urine reduced and a high proportion of the weight gain, high level of C-reactive protein, NT-proBNP levels, lower levels of glomerular filtration rate, left ventricular ejection fraction lower ACEI drug, the ARB class of drugs, p receptor The proportion of low-blocker use, diuretic use, a high proportion of the above P lt; 0.05. Renal insufficiency with normal renal function, mild renal impairment compared mortality during the first hospitalization, within 2 years after the onset of mortality and heart failure hospitalization rates again recurrent coronary events, and malignant arrhythmia significantly higher rate of incidence from the short time of death, re-hospitalization for heart failure an increase in the number and length of hospital stay for the first time, and again 2 years total hospital longer in patients with heart failure, heart failure and malignant arrhythmia leading to death, a higher proportion of the above both P lt; 0.05. Using Logistic regression analysis of risk factors, renal insufficiency affecting hospital mortality of elderly patients with chronic heart failure, 2 years after the onset of an independent risk factor for mortality, heart failure hospitalization rate again. Conclusion: The high incidence of renal dysfunction in patients with chronic heart failure admission; renal dysfunction in patients age more than large, poor cardiac function. Compared with normal renal function, and more associated with old myocardial infarction, acute myocardial infarction, hypertension, diabetes, lung infections, anemia, c-reactive protein, NT-proBNP was significantly higher, the high proportion of diuretics and spironolactone, Use ACEI low proportion. And hospital mortality, 2 years after the onset of mortality, incidence from the short time of death, recurrent high incidence of coronary events and malignant ventricular arrhythmia; easy because of the progression of heart failure and malignant arrhythmia and death, heart failure hospitalization rates again high again heart failure hospitalization times, 2 years total hospitalization time of the first hospitalization and patients with heart failure hospitalized again. Renal dysfunction affecting hospital mortality of elderly patients with chronic heart failure, 2 years after the onset of mortality, independent risk factor for heart failure hospitalization rate again.
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