title: Worsening renal function in patients admitted with acute decompensated heart failure: incidence, risk factors and prognostic implications.
abstract: OBJECTIVE
  Acute decompensated heart failure (ADHF) is a common cause of hospital admission and is associated with an increased risk of worsening renal function (WRF). The aims of this study were to investigate the incidence and predictors of WRF in patients admitted for ADHF and to assess the prognostic significance of WRF at 1 year.
  
  
  METHODS
  A retrospective analysis of data on 200 consecutive patients admitted with ADHF was carried out. By definition, WRF occurred when the serum creatinine level increased during hospitalization by 0.3 mg/dL and by > or =25% from admission.
  
  
  RESULTS
  Overall, 23% of patients developed WRF. On multivariate analysis, age >80 years (odds ratio [OR]=2.72; 95% confidence interval [CI], 1.86-3.42), admission glomerular filtration rate <60 mL/min per 1.73 m2 (OR=2.05; 95% CI, 1.53-2.27) and admission systolic pressure <90 mmHg (OR=1.61, 95% CI, 1.17-3.22) were independently associated with WRF. The rate of mortality or readmission for heart failure (HF) at 1 year was higher in the WRF group (P< .01 by log-rank test). The median hospital stay was 9 days for patients with WRF and 4 days for those without (P< .05). On multivariate analysis, WRF remained independently 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 common complication and was associated with a longer hospital stay and an increased risk of mortality or HF hospitalization. Clinical characteristics at admission can help identify patients at an increased risk of WRF.
authors.affiliation: Servicio de Cardiologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. cesar.belziti@hospitalitaliano.org.ar
authors.forename: César A
authors.initials: CA
authors.lastname: Belziti
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagnati
authors.forename: Paola
authors.initials: P
authors.lastname: Ledesma
authors.forename: Norberto
authors.initials: N
authors.lastname: Vulcano
authors.forename: Sandra
authors.initials: S
authors.lastname: Fernández
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index