Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry

Abstract

Background: Worsening renal function (WRF) is associated with adverse outcomes in patients with heart failure. We investigated the predictors and prognostic value of WRF during admission, in patients with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF).

Methods and results: A total of 5625 patients were enrolled in the KorAHF (Korean Acute Heart Failure) registry. WRF was defined as an absolute increase in creatinine of ≥0.3 mg/dL. Transient WRF was defined as recovery of creatinine at discharge, whereas persistent WRF was indicated by a nonrecovered creatinine level. HFpEF and HFrEF were defined as a left ventricle ejection fraction ≥50% and ≤40%, respectively. Among the total population, WRF occurred in 3101 patients (55.1%). By heart failure subgroup, WRF occurred more frequently in HFrEF (57.0% versus 51.3%; P<0.001 in HFrEF and HFpEF). Prevalence of WRF increased as creatinine clearance decreased in both heart failure subgroups. Among various predictors of WRF, chronic renal failure was the strongest predictor. WRF was an independent predictor of adverse in-hospital outcomes (HFrEF: odds ratio; 2.75; 95% confidence interval, 1.50-5.02; P=0.001; HFpEF: odds ratio, 9.48; 95% confidence interval, 1.19-75.89; P=0.034) and 1-year mortality (HFrEF: hazard ratio, 1.41; 95% confidence interval, 1.12-1.78; P=0.004 versus HFpEF: hazard ratio, 1.72; 95% confidence interval, 1.23-2.42; P=0.002). Transient WRF was a risk factor for 1-year mortality, whereas persistent WRF had no additive risk compared to transient WRF.

Conclusions: In patients with acute heart failure patients, WRF is an independent predictor of adverse in-hospital and follow-up outcomes in both HFrEF and HFpEF, though with a different effect size.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01389843.

Keywords: heart failure; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; renal function.

Figure 1

Prevalence of WRF and persistent WRF. WRF occurred in 55.1% of the total population, among which 38.1% showed persistent WRF. In subgroups of HFrEF and HFpEF, WRF and persistent WRF were more common in the HFrEF group. Abbreviations: HFrEF indicates heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; WRF, worsening renal function.

Figure 2

Prevalence of WRF by CRF stage. Prevalence of WRF increased along with the decrease of initial GFR at admission. Dark wine color represents persistent WRF, and gray color represents transient WRF. Both transient and persistent WRF increased as GFR grade decreased, in the (A) total study population, (B) HFrEF group, and (C) HFpEF group. GFR indiactes glomerular filtration rate; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; WRF, worsening renal function.

Figure 3

Survival curve of the total population by the severity of WRF. Short‐term (3‐month) and long‐term (1‐year) mortality increased with severity of WRF in (A) the total study population, (B) the HFrEF group, and (C) the HFpEF group. HFpEF indicates heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; WRF, worsening renal function.