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Men made up The mean GFR was Figure 1. Frequency histogram showing different glomerular filtration rates GFR in the study population.. Table 1 shows all the variables analyzed.. In addition, these patients more commonly fell into higher NHYA classes. No significant differences were seen between the three kidney failure severity groups with respect to the prescription of beta-blockers. Neither the prevalence of left ventricular systolic dysfunction nor atrial fibrillation was correlated to the degree of kidney failure..

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Mean follow-up time was 1. Twenty three patients Kaplan-Meier analysis showed notably higher mortality among the severe kidney failure patients mean survival, 1. At one year of follow-up, survival increased progressively over the first 3 GFR quartiles A slight decrease was seen, however, for the highest quartile Figure 2. GFR indicates glomerular filtration rate; RR, relative risk.. Figure 3. Annual survival of total patients, those with preserved left ventricular systolic function PSF and reduced left ventricular systolic function RSF with respect to glomerular filtration rate quartiles..

Independent of other variables significantly related to long term survival in univariate analysis, the influence of severe kidney failure was confirmed by the multivariate Cox model; the maximum relative risk RR was 2. In contrast, moderate kidney failure was not significantly associated with long term survival. Other independent variables related to higher mortality were age and anemia. Treatment with ACE inhibitors was protective Table Differences were seen in the influence of severe kidney failure on survival between patients prescribed and not prescribed ACE inhibitors at discharge.

Kidney failure was nighy prevalent in both subgroups of patients those with preserved and those with reduced left ventricular systolic function Figure 4 , affecting approximately half the members of each. In the "preserved" subgroup, survival was reduced from 2. In the "reduced" subgroup survival was reduced from 2. Figure 4. Proportion of patients with different degrees of kidney failure in the preserved PSF and reduced left ventricular function RSF subgroups.. Figure 5. GFR indicates glomerular filtration rate..

The influence of severe kidney failure on prognosis was powerful and independent of other variables significantly as sociated with survival in both the preserved and reduced systolic function subgroups Table The results show that kidney failure is independently associated with mortality among patients hospitalized for CHF. This association was seen both in patients with preserved and reduced left ventricular systolic function. This association was independent of age, the presence of diabetes mellitus, blood pressure, or any other risk factors for mortality.

Of all the factors found to be independently associated with mortality, kidney failure was the most important, especially amongst patients belonging to the reduced systolic function subgroup. Patients with more severe kidney failure showed a worse cardiovascular risk profile; this shows that, in patients with CHF, cardiovascular and renal disease develop in a parallel manner.


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Ezekowitz et al 22 recently described kidney failure to be very prevalent amongst patients with CHF and ischemic heart disease, and that this coexistence was associated with more advanced coronary atherosclerosis. Similary, in our patients, an inverse relationship was seen between GFR values and the prevalence of ischemic heart disease..

The present results underline the importance of kidney failure as a powerful risk factor for mortality in patients hospitalized due to CHF, whether their left ventricular systolic function is preserved or not. They also show that patients with moderate kidney failure can have apparently normal serum creatinine levels--something often seen in the elderly population.. Several papers have reported an association between the deterioration of kidney function and the prognosis of patients with different types of clinical cardiovascular disease.

This increased risk was independent of other variables with influence on patient prognosis. The increased risk of death in outpatients with moderate kidney failure and CHF is well known, especially in those with reduced left ventricular systolic dysfunction. Kidney failure might be a marker of more advanced CHF, is associated with a greater prevalence of other cardiovascular risk factors, and might limit the use of drugs known to have a positive impact on prognosis such as ACE inhibitors. It may be that the relationship between kidney failure and CHF is bidirectional: the former might accelerate the progression of the latter, and the latter influence the appearance of the former.

To some extent the present results suggest such relationships since patients with more advanced kidney failure had a worse cardiovascular risk profile. However, further research is needed to determine the exact nature of the relationship between kidney failure and CHF, in particular to establish whether the stabilization of kidney failure is associated with improved survival.. As mentioned above, the association between mortality and kidney failure was noted in both the preserved and reduced systolic function subgroups of patients.

Bearing in mind the physiopathology of CHF with preserved left ventricular systolic function, it is possible that the pathogenesis of both CHF and kidney failure is the same, and that they reflect a parallel progression of cardiovascular and renal disease. Several clinical trials are currently underway to determine the most adequate treatment for CHF with preserved left ventricular systolic dysfunction. Given the high prevalence of kidney failure associated with this clinical form of CHF, and its association with mortality, it is in such patients that the effectiveness of therapeutic strategies with respect to the degree of kidney failure should be investigated..

Given the important relationship between kidney failure and the prognosis of patients with CHF, we believe it wise to assess renal function--at least in terms of the GFR--as part of clinical evaluation and follow-up strategies. The presence of kidney failure should oblige potentially treatable causes be sought, and calls for the use of drugs known to be beneficial--ACE inhibitors and beta-blockers. The results of recent studies highlight the prognostic benefits of treatment with these agents in patients with CHF and kidney failure.

Similarly, in a study involving patients, 22 ACE inhibitors and beta-blockers significantly improved the prognosis of patients with CHF and kidney failure.. The present work also identified other factors that independently influenced patient prognosis. A very strong association was seen between the presence of anemia and CHF; anemia would appear to negatively and significantly affect patient prognosis.

However, further work is needed to determine whether the stabilization of kidney failure in patients with CHF has any favorable effect on the presence of anemia, to establish whether the correction of anemia has any effect on the survival of such patients, and to assess whether such correction prevents further deterioration of kidney function..

Kidney failure is a powerful predictor of mortality in patients hospitalized for CHF, irrespective of whether left ventricular systolic function is preserved or reduced. In the present patients, kidney failure was associated with a worse cardiovascular risk profile, suggesting that cardiovascular and renal disease progress together in CHF.

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Treatment with ACE inhibitors can attenuate the increased risk of death due to kidney failure.. It is recommended that the assessment of kidney function be included in clinical examinations of patients with CHF. Further experimental and clinical research is needed to clarify the mechanisms that justify the association between CHF and kidney failure, and to determine the best therapeutic strategies to follow, both in patients with reduced but especially with preserved left ventricular systolic function..

See editorial on pages Correspondence: Dr. E-mail: jose. Received March 22, Accepted for publication November 3, Home Articles in press Current Issue Archive.

ISSN: Previous article Next article. Issue 2. Pages February More article options. Download PDF. This item has received. Article information. TABLE 1. TABLE 2. TABLE 3. TABLE 4. Show more Show less. Palabras clave:. Insuficiencia renal. Introduction and objectives. Most clinical trials that demonstrated the negative impact of renal failure on survival in patients with congestive heart failure CHF included a relatively small proportion of subjects with a high creatinine level and were performed in patients with depressed left ventricular systolic function.

Our aim was to investigate the clinical characteristics and prognosis of hospitalized CHF patients with depressed or preserved systolic function and different degrees of renal dysfunction. Patients and method. The study included consecutive CHF patients admitted to a hospital department of cardiology between Patients with severe renal failure had the worst cardiovascular risk profile: older age, higher prevalence of cardiovascular risk factors, anemia, inflammatory markers in plasma, and less prescription of angiotensin-converting enzyme ACE inhibitors.

The negative impact of severe renal failure on prognosis was reduced by ACE inhibitor use. Renal failure is common and a strong predictor of mortality in hospitalized CHF patients with or without depressed systolic function. It is associated with a worse risk profile.. Patients with the latter type of CHF are usually elderly, more likely to be women, and to show a higher prevalence of diabetes and high blood presure, 19,20 factors that could influence the association between kidney failure and mortality.

In addition, an analysis was made to determine whether the degree of kidney failure is associated with different cardiovascular risk profiles. PATIENTS AND METHODS Study Population, Selection Criteria, and Definitions Between 1 January and 31 December , patients with CHF, as defined by the modified Framingham criteria major criteria: paroxysmal nocturnal dyspnea, orthopnea, pulmonary crackling, jugular vein engorgement, third heart sound, radiological signs of pulmonary congestion, and cardiomegaly; minor criteria: exercise dyspnea, peripheral edema, hepatomagaly, and pleural effusion , were admitted to the cardiology department of a tertiary hospital in northwestern Spain.

The final study population was composed of patients. Variables Analyzed The following variables were recorded: demographics cardiovascular risk factors, CHF etiology, clinical status, the results of complementary tests chest x-ray, electrocardiogram, blood analysis , and the treatment prescribed at discharge.

This small group of patients showed no significant differences to the remaining patients in their clinical characteristics. The log rank test was used to compare differences in survival. Rev Esp Cardiol, 57 , pp. Rev Clin Esp, , pp. Diastolic heart failure:neglected or misdiagnosed?

Paul Doyle on books, writing & short stories, often in Spanish

J Am Coll Cardiol, 39 , pp. Heart failure with preserved left ventricular systolic function.. J Am Coll Cardiol, 43 , pp. Whereas in Guatemala people are advised that:. In England:. One of the favourites that I came across while I was trawling the internet buscando was this Chinese proverb:. Una mujer inquisitiva es capaz de dar la vuelta al arco iris solo para ver lo que hay en el otro lado. Spain and England seem to agree about how women can be dangerous when angered, although the root of this phrase is biblical so neither country can take all the blame ser culpable.

You should fear the worst from April and women. Hell hath no fury like a woman scorned.

Salvatore Adamo - Todo Adamo (sus grandes éxitos en español)

There are many more examples of the way women have been viewed over the centuries contained in sayings and proverbs but what about today? How is language evolving when it comes to the equality of the sexes? A classic example that I came across a few years ago was the concept straight from Hollywood of Dad bod or in Spanish: fofi sano. I loved the Spanish translation of this — especially as it could be used in the feminine: fofi sana sounds great, but my concern was with the implied reference to body image that still exists.

Works (179)

Is anyone winning the battle of the sexes? Remedios Varo, cuando lo importante es el trabajo. Anders Leonard Zorn, el sueco que jugaba con la luz. Gloria Fuertes, mendiga de todo, menos de amor. Augusto Roa Bastos, el patriota desterrado. Cumplen siglo en el Capaces y competentes.


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  8. What do they say? A woman needs a man like a fish needs a bicycle. Merry Christmas! To mince your words. Microrrelatos: Historias de terror. Microrrelatos: A partir de un nombre Microrrelatos: Micro-descripciones de amigas o amigos. Autores de septiembre.