title: Worsening renal function in heart failure: the need for a consensus definition.
abstract: Acute decompensated heart failure is a common cause of hospitalisation. This is a period of vulnerability both in altered pathophysiology and also the potential for iatrogenesis due to therapeutic interventions. Renal dysfunction is often associated with heart failure and portends adverse outcomes. Identifying heart failure patients at risk of renal dysfunction is important in preventing progression to chronic kidney disease or worsening renal function, informing adjustment to medication management and potentially preventing adverse events. However, there is no working or consensus definition in international heart failure management guidelines for worsening renal function. In addition, there appears to be no concordance or adaptation of chronic kidney disease guidelines by heart failure guideline development groups for the monitoring of chronic kidney disease in heart failure. Our aim is to encourage the debate for an agreed definition given the prognostic impact of worsening renal function in heart failure. We present the case for the uptake of the Acute Kidney Injury Network criteria for acute kidney injury with some minor alterations. This has the potential to inform study design and meta-analysis thereby building the knowledgebase for guideline development. Definition consensus supports data element, clinical registry and electronic algorithm innovation as instruments for quality improvement and clinical research for better patient outcomes. In addition, we recommend all community managed heart failure patients have their baseline renal function classified and routinely monitored in accordance with established renal guidelines to help identify those at increased risk for worsening renal function or progression to chronic kidney disease.
authors.affiliation: Centre for Cardiovascular and Chronic Care, University of Technology, Sydney, Australia. Electronic address: noella.j.sheerin@student.uts.edu.au.
authors.forename: Noella J
authors.initials: NJ
authors.lastname: Sheerin
authors.affiliation: Centre for Cardiovascular and Chronic Care, University of Technology, Sydney, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.affiliation: St Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Macdonald
authors.affiliation: Sydney Southwest Local Health District, Liverpool, NSW, Australia.
authors.forename: Dominic Y C
authors.initials: DY
authors.lastname: Leung
authors.affiliation: Australian Research Centre in Complementary & Integrative Medicine, University of Technology, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Sibbritt
authors.affiliation: Sydney Southwest Local Health District, Liverpool, NSW, Australia.
authors.forename: Stephen Timothy
authors.initials: ST
authors.lastname: Spicer
authors.affiliation: St Vincent's Hospital, Sydney, Australia.
authors.forename: Kay
authors.initials: K
authors.lastname: Johnson
authors.affiliation: CCRE Therapeutics, Monash University, Melbourne, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.affiliation: Johns Hopkins University, Baltimore, USA.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D000818:Animals; D032921:Consensus; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000502:physiology*; D015201:Meta-Analysis as Topic; D012189:Retrospective Studies
keywords: Acute kidney injury; Cardiorenal; Creatinine; Heart failure; Worsening renal function