Prognostic impact of renal dysfunction does not differ according to the clinical profiles of patients: insight from the acute decompensated heart failure syndromes (ATTEND) registry

Abstract

Background: Renal dysfunction associated with acute decompensated heart failure (ADHF) is associated with impaired outcomes. Its mechanism is attributed to renal arterial hypoperfusion or venous congestion, but its prognostic impact based on each of these clinical profiles requires elucidation.

Methods and results: ADHF syndromes registry subjects were evaluated (N = 4,321). Logistic regression modeling calculated adjusted odds ratios (OR) for in-hospital mortality for patients with and without renal dysfunction. Renal dysfunction risk was calculated for subgroups with hypoperfusion-dominant (eg. cold extremities, a low mean blood pressure or a low proportional pulse pressure) or congestion-dominant clinical profiles (eg. peripheral edema, jugular venous distension, or elevated brain natriuretic peptide) to evaluate renal dysfunction's prognostic impact in the context of the two underlying mechanisms. On admission, 2,150 (49.8%) patients aged 73.3 ± 13.6 years had renal dysfunction. Compared with patients without renal dysfunction, those with renal dysfunction were older and had dominant ischemic etiology jugular venous distension, more frequent cold extremities, and higher brain natriuretic peptide levels. Renal dysfunction was associated with in-hospital mortality (OR 2.36; 95% confidence interval 1.75-3.18, p<0.001), and the prognostic impact of renal dysfunction was similar in subgroup of patients with hypoperfusion- or congestion-dominant clinical profiles (p-value for the interaction ranged from 0.104-0.924, and was always >0.05).

Conclusions: Baseline renal dysfunction was significantly associated with in-hospital mortality in ADHF patients. The prognostic impact of renal dysfunction was the same, regardless of its underlying etiologic mechanism.

Figure 1. Distribution of estimated glomerular filtration rates levels on admission to hospital.

GFR, glomerular filtration rate

Figure 2. Evaluation of the receiver operating characteristic curve for renal dysfunction.

The area under the curve was 0.63 (95% confidence interval = 0.61–0.64, p<0.001), and the cut-off value for the greatest sensitivity and specificity was 50.25 mL/min/1.73 m². GFR, glomerular filtration rate; CI, confidence interval; ROC, receiver operating characteristic.

Figure 3. Relationship between the baseline estimated glomerular filtration rates and in-hospital mortality.

eGFR, estimated glomerular filtration rate.

Figure 4. The prognostic impact of renal dysfunction in the prediction of all-cause mortality in relation to the underlying etiologic mechanisms.

LVEF, left ventricular ejection fraction; mBP, mean blood pressure; PPP, proportional pulse pressure; JVD, jugular venous distension; BNP, brain natriuretic peptide.