Worsening renal function in patients with acute decompensated heart failure treated with ultrafiltration: predictors and outcomes.
BACKGROUND
Ultrafiltration (UF) is used to treat patients with diuretic-resistant acute decompensated heart failure. The aim of this study was to identify predictors and the effect of worsening renal failure (WRF) on mortality in patients treated with UF.


RESULTS
Based on changes in serum creatinine, 99 patients treated with UF were divided into WRF and control groups. Overall creatinine increased from 1.9 ± 9.7 to 2.2 ± 2.0 mg/dL (P < .001), and WRF developed in 41% of the subjects. The peak UF rate was higher in the WRF group in univariate analysis (174 ± 45 vs 144 ± 42 mL/h; P = .03). Based on multivariate analysis, aldosterone antagonist treatment (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.17-13.46, P = .04), heart rate ≤65 beats/min (OR 6.03, 95% CI 1.48-48.42; P = .03), and E/E' ≥15 (OR 3.78, 95% CI 1.26-17.55; P = .04) at hospital admission were associated with WRF. Patients with baseline glomerular filtration rate (GFR) ≤60 mg/dL who developed WRF during UF had a 75% 1-year mortality rate.


CONCLUSIONS
WRF occurred frequently during UF. Increased LV filling pressures, lower heart rate, and treatment with aldosterone antagonist at hospital admission can identify patients at increased risk for WRF. Patients with baseline GFR ≤60 mg/dL and WRF during UF have an extremely high 1-year mortality rate.
Division of Cardiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: eraichlin@unmc.edu.
Eugenia
E
Raichlin
Division of Cardiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Nicholas A
NA
Haglund
Division of Cardiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Ioana
I
Dumitru
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Elizabeth R
ER
Lyden
Division of Cardiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Michael D
MD
Johnston
Division of Cardiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Joan M
JM
Mack
Division of Cardiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
John R
JR
Windle
Division of Cardiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Brian D
BD
Lowes
D000208:Acute Disease; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006440:Hemofiltration / Q000379:methods / Q000401:mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007668:Kidney / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014462:Ultrafiltration / Q000379:methods / Q000639:trends
Acute decompensated heart failure; ultrafiltration; worsening renal function