Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance.
BACKGROUND
Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF).


RESULTS
We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a > or =25% and a > or =0.3 mg/dL increase in serum creatinine (s-Cr) from admission (WRF-Abs-%).


RESULTS
Patients were followed for 480+/-363 days. Fifty-three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF-Abs-% occurred in 107 (34%) patients. At multivariable survival analysis, WRF-Abs-% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13-1.81; p=0.024). The independent predictors of WRF-Abs-%, evaluated using multivariable logistic regression, were history of chronic kidney disease (p=0.002), LV ejection fraction (p=0.012), furosemide daily dose (p=0.03) and NYHA class (p=0.05) on admission.


CONCLUSIONS
WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.
Metra
Marco
M
Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Italy. metramarco@libero.it
Nodari
Savina
S
Parrinello
Giovanni
G
Bordonali
Tania
T
Bugatti
Silvia
S
Danesi
Rossella
R
Fontanella
Benedetta
B
Lombardi
Carlo
C
Milani
Patrizia
P
Verzura
Giulia
G
Cotter
Gadi
G
Dittrich
Howard
H
Massie
Barry M
BM
Dei Cas
Livio
L
D000368:Aged; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
D004232:Diuretics; D005665:Furosemide; D003404:Creatinine