Frequency, predictors and prognosis of worsening renal function in patients admitted with acute heart failure

Abstract

Objective: To calculate frequency of worsening renal failure (WRF) in patients with acute decompensated heart failure (ADHF), to evaluate predictors of WRF and to assess its effect on in-hospital and 12 month adverse outcomes.

Methods: A single center observational prospective study was conducted on consecutive patients admitted with ADHF from Sept 2016 - February 2017. Follow-up was done for 12 months post discharge. Data were obtained from electronic medical records and telephonic calls. Early adverse outcome was composite of hospital mortality, prolonged length of stay (LOS) >4days or new need for haemodialysis. Intermediate term adverse event was composite of 12 months all-cause mortality or re-hospitalization.

Results: Total of 247 ADHF patients were admitted. Mean age was 67.6±33.4 years. Males were 163 (65.9%). WRF was found in 57 (23.1%) patients. Predictors of WRF were age>70years, furosemide dose>400mg and admission eGFR <60ml/min. The odds of composite in-hospital outcomes were four times higher in WRF compared to stable renal function (38.6% versus 13.2%, (p<0.01) but were mainly driven by prolonged LOS (4.2 vs. 2.2 days respectively). Follow up was available for 230(97%). Intermediate term outcome was not different between two groups on log rank test.

Conclusions: WRF is a significant problem in ADHF, is common in elderly patients, with baseline impaired renal function and is associated with high requirement of diuretics and prolonged hospital stay. Composite of mortality or HF hospitalization at 12 months was not different between the two groups.

Keywords: Worsening renal function, decompensated heart failure, chronic kidney disease..