Association between Left Ventricular Ejection Fraction and Worsening Renal Function in Acute Heart Failure: Insights from the RELAX-AHF-2 Trial

Abstract

Background Worsening renal function (WRF) occurs commonly during episodes of acute heart failure (AHF). However, the association between left ventricular ejection fraction (LVEF) and WRF in patients with AHF is uncertain. Consequently, we assessed the development of WRF over a broad range of LVEF in patients with a broad range of LVEF who were hospitalized with AHF. Methods We analyzed data from 6,128 patients enrolled in the in RELAX-AHF 2 trial who had LVEF measured during AHF hospitalization. Patients were categorized in quartiles according to LVEF: Q1, LVEF 7-29%; Q2, LVEF 29-38%; Q3, LVEF 38-50% and Q4, LVEF 50-87%. WRF was defined as a rise in serum creatinine of ≥0.3 mg/dL from baseline through day 5 in the hospital. Results The incidence of WRF through hospital day 5 was higher in the HFpEF cohort (Q4) compared with the lowest LVEF group (Q1) (34.3% vs. 23%; OR 1.94, 95%CI 1.52-2.48, P Conclusions WRF during AHF hospitalization was higher in HFpEF than in HFrEF patients. Evidence of a lower weight loss and persistence of residual congestion in HFpEF vs HFrEF patients were factors associated with WRF in HFpEF group. These findings demonstrate that HFpEF patients are more likely to develop WRF during AHF hospitalization than HFrEF patients and they suggest that residual congestion may play a role in this process.