 Renal dysfunction is a common comorbidity, as well as a common and progressive complication, of heart failure HF. Increasingly, the clinical syndrome of HF is one of cardiorenal failure owing to the frequent presentation of combined cardiac and renal dysfunction. Recent studies have established the prognostic importance of renal dysfunction in patients with chronic HF. An analysis of the patients in the second prospective randomized study of Ibopamine on mortality and efficacy PRIME by Hillege et al1 demonstrated that estimated glomerular filtration rate GFR is the most powerful predictor of mortality, exceeding functional status and ejection fraction EF. 