Transient worsening of renal function during hospitalization for acute heart failure alters outcome.
OBJECTIVE
We studied prevalence, causes and consequences of worsening renal function (WRF) during hospitalization for acute heart failure (AHF).


METHODS
Patients admitted for AHF were enrolled. Patients with severe chronic renal failure, cardiogenic shock and contrast medium-induced nephropathy were excluded. WRF was defined as an increase of 25 mumol/l or more in serum creatinine relative to the admission level. Survivors were monitored for 6 months, focusing on deaths and first unscheduled readmissions for heart failure.


RESULTS
Among the included 416 patients, WRF occurred in 152 cases (37%), 5+/-3 days after admission, and two-thirds of patients recovered their baseline renal function before discharge. Old age, diabetes, hypertension and acute coronary syndromes increased the risk of WRF. In-hospital furosemide doses as well as discharge treatment were similar in WRF and no-WRF patients. Serum creatinine elevation was the strongest independent determinant of a longer hospital stay (r=0.37, p=0.001). Adverse events occurred in 158 patients (38%) during follow-up, with 23 deaths and 135 readmissions. Cox analysis showed that WRF, transient or not, was an independent predictor of the risk of death or readmission (hazard ratio=1.74 [1.14-2.68], p=0.01).


CONCLUSIONS
WRF is frequent after admission for AHF and, although transient, is associated with longer hospitalization and with a higher risk of death and readmission, irrespectively of baseline renal function.
Logeart
Damien
D
Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France. damien.logeart@lrb.ap-hop-paris.fr
Tabet
Jean-Yves
JY
Hittinger
Luc
L
Thabut
Gabriel
G
Jourdain
Patrick
P
Maison
Patrick
P
Tartiere
Jean-Michel
JM
Solal
Alain Cohen
AC
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D003404:Creatinine