Clinical Impact of Worsening Renal Function in Patients with Acute Decompensated Heart Failure

Abstract

AbstractBackground: The population of aging patients with heart failure (HF) israpidly increasing, especially in developed countries. Aging causesstructural and functional changes to the cardiovascular system andorgans, including the heart and kidneys. The clinical significance ofworsening renal function (WRF) in patients with acute decompensate heartfailure (ADHF) is not completely understood.Objective: To assess the Clinical Impact of Worsening Renal Function inPatients with Acute Decompensated Heart Failure.Methods: The prospectively observational cohort study was conducted inthe Department of Cardiology, Enam Medical College & Hospital, Savar,Bangladesh between January 2019 to Jun 2020. A retrospective analysis ofdata on 200 consecutive patients admitted with ADHF was carried out. Bydefinition, WRF occurred when the serum creatinine level increased duringhospitalization by 0.3 mg/dL and by 25% from admission.Results. Overall, 23% of patients developed WRF. On multivariateanalysis, age >70 years (odds ratio [OR] = 2.72; 95% confidence inter-val[CI], 1.86-3.42), admission glomerular filtration rate <60 mL/min per 1.73m2 (OR=2.05; 95% CI, 1.53-2.27) and admission systolic pressure <90mm Hg (OR=1.61; 95% CI, 1.17-3.22) were indepen-dently associatedwith WRF. The rate of mortality or readmission for heart failure (HF) at 1year was higher in the WRF group (P<.01 by log-rank test). Themedian hospital stay was 9 days for patients with WRF and 4 days forthose without (P<.05). On multivariate analysis, WRF remainedindependently associated with mortality or HF rehospitalization (hazard ratio= 1.65; 95% CI, 1.12-2.67; P=.003).Conclusions: In patients admitted for ADHF, WRF was a commoncomplication and was associated with a longer hospital stay and an increasedrisk of mortality or HF hospitalization. Clinical characteristics at admissioncan help identify patients at an increased risk of WRF. The primary endpointwas a composite of cardiac events within 1 year. The patients in the over-70,WRF group presented more significant mean blood pressure (MBP) dropsthan those in the over-70 non- WRF group (p=0.003). Logistic regressionanalyses revealed that higher MBP at admission was a significant predictorof WRF.