Abstract
BackgroundThe role of worsening renal function during acute heart failure (AHF) hospitalization is still debated. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements.ObjectivesTo investigate the prognostic relevance of different RF trajectories together with the congestion status in hospitalized patients.MethodsThis is a post hoc analysis of a multi-center study including 467 patients admitted with AHF who were screened for the Diur-AHF Trial. We recognized five main RF trajectories based on serum creatinine and estimated glomerular filtration rate (eGFR) behavior. According to the RF trajectories our sample was divided into 1-stable (S), 2-transient improvement (TI), 3-permanent improvement (PI), 4-transient worsening (TW), and 5-persistent worsening (PW). The primary outcome was the combined endpoint of 180 days including all causes of mortality and re-hospitalization.ResultsWe recruited 467 subjects with a mean congestion score of 3.5±1.08 and a median creatinine value of 1.28 (1.00–1.70) mg/dl, eGFR 50 (37–65) ml/min/m2 and NTpro B-type natriuretic peptide (BNP) 7,000 (4,200–11,700) pg/ml. A univariate analysis of the RF pattern demonstrated that TI and PW patterns were significantly related to poor prognosis [HR: 2.71 (1.81–4.05); p < 0.001; HR: 1.68 (1.15–2.45); p = 0.007, respectively]. Conversely, the TW pattern showed a significantly protective effect on outcome [HR:0.34 (0.19–0.60); p < 0.001]. Persistence of congestion and BNP reduction ≥ 30% were significantly related to clinical outcome at univariate analysis [HR: 2.41 (1.81–3.21); p < 0.001 and HR:0.47 (0.35–0.67); p < 0.001]. A multivariable analysis confirmed the independently prognostic role of TI, PW patterns, persistence of congestion, and reduced BNP decrease at discharge.ConclusionsVarious RF patterns during AHF hospitalization are associated with different risk(s). PW and TI appear to be the two trajectories related to worse outcome. Current findings confirm the importance of RF evaluation during and after hospitalization.
Highlights
Renal function (RF) deterioration occurring in acute heart failure (AHF) is one of the most important features during hospitalization with several repercussions on treatment and prognosis
The patients screened were over the age of 18 years and were admitted with dyspnoea, evidence of volume overload, and/or clinical signs of HF in whom a diagnosis of AHF was confirmed by chest Xray and/or elevated (>1,500 pg/ml) levels of Amino-terminal (NT) pro-B-type natriuretic peptide (BNP)
The initial study population consisted of 499 patients enrolled in three different hospitals with a primary diagnosis of AHF
Summary
Renal function (RF) deterioration occurring in acute heart failure (AHF) is one of the most important features during hospitalization with several repercussions on treatment and prognosis. Predisposing common risk factors, such as diabetes, smoking, metabolic disorders, and hypertension, could amplify the cardiac and kidney atherosclerosis process and increase neurohormonal overdrive, leading to a final systemic and renal hemodynamic derangement [11]. This assessment should be considered during AHF hospitalization and should be interpreted by looking at both the individual patients and their primary cardiac and renal disorder. The current cardio-renal syndrome type 1 (CRS-1) update only recognizes the primary and secondary organ damage [12, 13] This definition does not yet provide an extensive interplay regarding the pathophysiological cross-talk, including predisposing factors, haemodynamic derangement, and preliminary kidney condition, implicated in its occurrence and organ deterioration [14]. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements
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