The prognostic importance of changes in renal function during treatment for acute heart failure depends on admission renal function

Abstract

Worsening and improving renal function during acute heart failure have been associated with adverse outcomes but few studies have considered the admission level of renal function upon which these changes are superimposed. Objectives The objective of this study was to evaluate definitions that incorporate both admission renal function and change in renal function. Methods 696 patients with acute heart failure with calculable EGFR were classified by admission renal function (Reduced [R, EGFR45 ml/min] or Preserved [P, EGFR45 ml/min]) and change over hospital admission (worsening [WRF]: EGFR 20% decline; stable [SRF]; and improving [IRF]: EGFR 20% increase). The primary outcome was all-cause mortality. The prevalence of Pres and Red renal function was 47.8%and 52.2%. The frequency of RWRF, R-SRF, and R-IRF was 11.4%, 28.7%, and 12.1%, respectively; the incidence of PWRF, P-SRF, and P-IRF was 5.7%, 35.3%, and 6.8%, respectively. Survival was shorter for patients with R-WRF compared to R-IRF (median survival times 13.9 months (95%CI 7.7- 24.9) and 32.5 months (95%CI 18.8-56.1), respectively), resulting in an acceleration factor of 2.3 (p=0.016). Thus, an increase compared with a decrease in renal function was associated with greater than two times longer survival among patients with Reduced renal function. Copyright: