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. 2011 Dec;17(12):993-1000.
doi: 10.1016/j.cardfail.2011.08.009. Epub 2011 Oct 1.

Clinical characteristics and outcomes of patients with improvement in renal function during the treatment of decompensated heart failure

Jeffrey M Testani  1 , Brian D McCauley, Jennifer Chen, Steven G Coca, Thomas P Cappola, Stephen E Kimmel
Affiliations

Clinical characteristics and outcomes of patients with improvement in renal function during the treatment of decompensated heart failure

Jeffrey M Testani et al. J Card Fail. 2011 Dec.

Abstract

Background: In the setting of acute decompensated heart failure, worsening renal function (WRF) and improved renal function (IRF) have been associated with similar hemodynamic derangements and poor prognosis. Our aim was to further characterize IRF and its associated mortality risk.

Methods and results: Consecutive patients with a discharge diagnosis of congestive heart failure at the Hospital of the University of Pennsylvania were reviewed. IRF was defined as a ≥20% improvement and WRF as a ≥20% deterioration in glomerular filtration rate. Overall, 903 patients met the eligibility criteria, with 31.4% experiencing IRF. Baseline venous congestion/right-side cardiac dysfunction was more common (P ≤ .04) and volume of diuresis (P = .003) was greater in patients with IRF. IRF was associated with a greater incidence of preadmission (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.6-6.7; P < .0001) and postdischarge (OR 1.8, 95% CI 1.2-2.7; P = .006) WRF. IRF was associated with increased mortality (adjusted hazard ratio 1.3, 95% CI, 1.1-1.7; P = .011), a finding largely restricted to patients with postdischarge recurrence of renal dysfunction (P interaction = .038).

Conclusions: IRF is associated with significantly worsened survival and may represent the resolution of venous congestion-induced preadmission WRF. Unlike WRF, the renal dysfunction in IRF patients occurs independently from the confounding effects of acute decongestion and may provide incremental information for the study of cardiorenal interactions.

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Conflict of interest statement

Disclosures: All authors have no potential conflicts of interest relevant to this work.

Figures

Figure 1
Figure 1
Pre-admission to admission change in estimated glomerular filtration rate in patients with and without in-hospital IRF. IRF: Improved renal function. IRF defined as a 20% improvement in glomerular filtration rate at any time during hospitalization. Comparison of change in GFR between patients with and without IRF p<0.0001 for both closest and best pre-admission GFR.
Figure 2
Figure 2
A/B Discharge to post-discharge change in estimated glomerular filtration rate in patients with and without in-hospital improved renal function. Panel A represents patients with improved renal function at any time during hospitalization and panel B represents patients that continued to meet criteria at the time of discharge. IRF: Improved renal function. IRF defined as a 20% improvement in glomerular filtration rate. Comparison of change in GFR between patients with and without IRF p<0.0001 for all comparisons aside for the closest GFR in patients with and without IRF at discharge where p=0.001.
Figure 2
Figure 2
A/B Discharge to post-discharge change in estimated glomerular filtration rate in patients with and without in-hospital improved renal function. Panel A represents patients with improved renal function at any time during hospitalization and panel B represents patients that continued to meet criteria at the time of discharge. IRF: Improved renal function. IRF defined as a 20% improvement in glomerular filtration rate. Comparison of change in GFR between patients with and without IRF p<0.0001 for all comparisons aside for the closest GFR in patients with and without IRF at discharge where p=0.001.
Figure 3
Figure 3
Survival curves for patients with improvement in renal function persistent at discharge (persistent-IRF), transient improvement in renal function no longer present at discharge (transient-IRF), and no improvement in renal function (no IRF). IRF: Improved renal function. IRF defined as a ≥20% improvement in glomerular filtration rate. Survival curves are adjusted for discharge glomerular filtration rate. P=0.032 for the difference in mortality between patients with persistent-IRF and transient-IRF.
Figure 4
Figure 4
Survival curves for the combination of groups with or without improvement in renal function and with or without deterioration in renal function after discharge. IRF: Improved renal function. IRF defined as a ≥20% improvement in glomerular filtration rate at discharge. Deterioration in renal function defined as the highest available post discharge glomerular filtration rate less than the discharge glomerular filtration rate. Survival curves are adjusted for discharge glomerular filtration rate.
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