FP265FRONTIERS IN CARDIORENAL SYNDROME: THE DECREASING CREATININE SCENARIO

Abstract

Introduction and Aims: Renal dysfunction is prevalent in acute decompensated heart failure admissions (ADHF) and configures cardiorenal syndrome (CRS). Knowledge in this area derives mainly from diuretic resistant patients (P) and those with serum creatinine (sCr) elevation. Nevertheless, a group of P are admitted with elevated sCr and improve after treatment (decrease sCr >0.3 mg/dl). We define this situation as reverse CRS (R-CRS). There is limited information in medical literature about this P subset. We aimed to describe clinical features and outcome of P admitted for ADHF episodes with descending sCr. Methods: Patients admitted due to ADHF between July, 2011 and December, 2016 were analyzed. Groups were divided according urine output and sCr behaviour and included isolated creatinine elevation (increase > 0.3 mg/dl from admission), descending sCr (R-CRS= improvement > 0.3 mg/dl from admission), diuretic resistance (RDIUR= diuresis > 1.5 ml/kg/hr alter dispensed treatment) or no CRS (no CRS= preserved urine output and normal and unchanged sCr). We analyzed demographic, biochemical, clinical variables and treatment at admission, hospitalization, at 6 and 12 months. P who received heart transplant or under chronic dialysis were excluded from this analysis. Results: A total of 947 consecutive P were included in this analysis. Study population included 56.5% of males, aged 71 6 15 years old (y). Isolated creatinine elevation was accounted in 29.6%; R-CRS in 13.3%, RDIUR in 9.6% and no CRS in 47.5%. P with R-CRS were more frequently men (67.5 vs 54.6%; p= 0.003) with diabetes (35.8 vs 26.5%; p= 0.02), lower admission systolic pressure (119628 vs 135 633 mmHg;p< 0.001), with similar age than general population (p= NS). While their baseline sCr was higher (1.776 0.7 vs 1.2 6 0.7 mg/dl; p< 0.001), renal function recovery occurred at day 3 (IQR 2-3), mainly due to fluid overload resolution (85%) than to hypoperfusion (15%). Compared with other groups, R-CRS was associated with liver dysfunction (OR 2.3; p=0.004). Most relevant clinical feature in R-CRS was hypoperfusion (26.1 vs 8.9%; p<0.001), with higher admission BNP (1084 vs 690 pg/ml; p<0.001) and lower left ventricular ejection fraction (38 616 vs42616%;p= 0.03). Length of hospital stay (LOS) was similar (6 vs 7 days; p= NS) for R-CRS. This P received more frequent inotropic support than P with no CRS or isolated sCr elevation (28 vs 13.7%; p< 0.001). In-hospital mortality was 11% in total population; with no differences concerning to R-CRS (OR 0.96; p= 0.88). Follow-up mortality rates were higher for R-CRS at 6-months (OR 1.65; p= 0.01) and 1-year (1.61; p= 0.01). Readmission rates were higher for R-CRS in al periods: 1-month (1.8; p= 0.01), 6-month (OR 2; p< 0.001) and 1-year (OR 1.9; p< 0.001). Conclusions: Descending creatinine is frequent in ADHF hospitalizations. It was associated with diabetes, hypoperfusion at admission and a higher event rate. It determined higher readmission rates and delayed mortality in ADHF. Considering improving renal function in ADHF should render in abetter comprehension in CRS epidemiology and outcome.