title: Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance.
abstract: 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.
authors.affiliation: Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Italy. metramarco@libero.it
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Giovanni
authors.initials: G
authors.lastname: Parrinello
authors.forename: Tania
authors.initials: T
authors.lastname: Bordonali
authors.forename: Silvia
authors.initials: S
authors.lastname: Bugatti
authors.forename: Rossella
authors.initials: R
authors.lastname: Danesi
authors.forename: Benedetta
authors.initials: B
authors.lastname: Fontanella
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Milani
authors.forename: Giulia
authors.initials: G
authors.lastname: Verzura
authors.forename: Gadi
authors.initials: G
authors.lastname: Cotter
authors.forename: Howard
authors.initials: H
authors.lastname: Dittrich
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: 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
chemical_list: D004232:Diuretics; D005665:Furosemide; D003404:Creatinine