Letter to the editor Renal failure in patients with acute heart failure Sevket Balta ⁎, Sait Demirkol, Ugur Kucuk, Zekeriya Arslan, Murat Unlu Department of Cardiology, Gulhane Medical Academy Ankara, Turkey article info Article history: Received 25 July 2013 Accepted 3 August 2013 Available online 15 August 2013 Keywords: Renal failure Acute heart failure Mortality Dear Editor, We read the article “Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure (AHF) and severe renal dysfunction (RD). Data from the Italian Registry IN-HF Outcome” by Giovanni Cioffi et al. with interest [1]. The authors aimed to define clinical characteristics and prognostic markers for short and mid-term mortalities in patients with severe RD admitted for AHF. They concluded that in patients with AHF and severe RD, in-hospital and one-year all- cause mortality rates are very high. Independent predictors such as older age, and signs of hypoperfusion and hyponatremia may be identi- fied but preventing and reversing RD remain the key targets for the clinical management of these patients’. Heart failure is one of the most significant disease which impairs quality of life and reduces lifetime. Heart failure (HF) is a highly preva- lent syndrome with a poor prognosis, resulting in substantial morbidity and reduced quality of life despite recent advances in treatment. Evalu- ation of prognosis is particularly important especially when counselling patients about devices and surgery and also in planning end-of-life care with patients, their family, and caregivers. Many variables provide prog- nostic information such as age, aetiology, New York Heart Association (NYHA) functional class, ejection fraction of left ventricle (EF), and co-morbidities like atrial fibrillation, respiratory disease [2], renal dys- function, diabetes, anaemia, hyperuricaemia [3]. In addition, compliance of medication and diet are also so important prognostic variables about both hospitalisation and mortality in patients with HF, whereas these conditions were not defined clearly in the study. Renal failure and so estimated glomerular filtration rate (eGFR) is one of the most important prognostic variable in patients with HF [4]. Modification of Diet in Renal Disease (MDRD) Formula have been selected by the authors to calculate eGFR in the study. The Cockcroft– Gault equation (CGE) is another method for calculating the GFR. However, the CGE may estimate lower GFR in younger age groups com- pared with the MDRD formula, but it can measure higher GFR in older individuals compared with the MDRD formula [5]. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently published an equation for GFR using the same variables (serum creatinine level, age, sex and race) as the MDRD formula. However, the CKD-EPI equation more precisely categorized individuals with respect to long-term clinical risk of incident end-stage renal disease, all-cause mortality, coronary heart disease and stroke compared with the MDRD formula [6]. Instead of using the MDRD formula, the authors would have better used the Ber- lin Initiative Study (BIS) equation (which estimates more precisely the GFR) or CKD-EPI [7]. References [1] Cioffi G, Mortara A, Di Lenarda A, et al. Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome. Int J Cardiol Jul 11 2013. http: //dx.doi.org/10.1016/j.ijcard.2013.06.020. [2] Aydogan M, Balta S, Demırkol S, Gumus S, Unlu M, Arslan Z. Closest friends: chronic pulmonary disease and systolic heart failure. Int J Cardiol May 24 2013. http: //dx.doi.org/10.1016/j.ijcard.2013.03.110. [3] McMurray JJV, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart. Eur Heart J Jul. 2012;33(14): 1787–847. [4] Goncalves C, Antunes A, Magalhaes F, Silva M, Gruner H, Ventura M. Cardiorenal syndrome in the elderly in an internal medicine ward. Eur Geriatr Med 2012;3(1):106. [5] Herzog CA. Kidney disease in cardiology. Nephrol Dial Transplant Jan 2009;24(1): 34–7. [6] Balta S, Demirkol S, Karaman M. Renal dysfunction may predict new onset heart failure. Am Heart J 2013 Sep;166(3):e5. [7] Schaeffner ES, Ebert N, Delanaye P, et al. Two novel equations to estimate kidney func- tion in persons aged 70 years or older. Ann Intern Med Oct 2 2012;157(7):471–81. International Journal of Cardiology 168 (2013) e131 ⁎ Corresponding author at: Department of Cardiology Gulhane School of Medicine, Tevfik Saglam St., 06018 Etlik-Ankara, Turkey. Tel.: +90 312 3044281; fax: +90 312 3044250. E-mail address: drsevketb@gmail.com (S. Balta). 0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2013.08.034 Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard