title: Worsening of renal function during 1 year after hospital discharge is a strong and independent predictor of all-cause mortality in acute decompensated heart failure.
abstract: BACKGROUND
  Renal impairment is a common comorbidity and the strongest risk factor for poor prognosis in acute decompensated heart failure (ADHF). In clinical practice, renal function is labile during episodes of ADHF, and often worsens after discharge. The significance of worsening of renal function (WRF) after discharge has not been investigated as extensively as baseline renal function at admission or WRF during hospitalization.
  
  
  RESULTS
  Among 611 consecutive patients with ADHF emergently admitted to our hospital, 233 patients with 3 measurements of serum creatinine (SCr) level measurements (on admission, at discharge, and 1 year after discharge) were included in the present study. Patients were divided into 2 groups according to the presence or absence of WRF at 1 year after discharge (1y-WRF), defined as an absolute increase in SCr >0.3 mg/dL (>26.5 μmol/L) plus a ≥25% increase in SCr at 1 year after discharge compared to the SCr value at discharge. All-cause and cardiovascular mortality were assessed as adverse outcomes. During a mean follow-up of 35.4 months, 1y-WRF occurred in 48 of 233 patients. There were 66 deaths from all causes. All-cause and cardiovascular mortality were significantly higher in patients with 1y-WRF (log-rank P<0.0001 and P<0.0001, respectively) according to Kaplan-Meier analysis. In a multivariate Cox proportional hazards model, 1y-WRF was a strong and independent predictor of all-cause and cardiovascular mortality. Hemoglobin and B-type natriuretic peptide at discharge, as well as left ventricular ejection fraction <50%, were independent predictors of 1y-WRF.
  
  
  CONCLUSIONS
  In patients with ADHF, 1y-WRF is a strong predictor of all-cause and cardiovascular mortality.
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Tomoya
authors.initials: T
authors.lastname: Ueda
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Rika
authors.initials: R
authors.lastname: Kawakami
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Yu
authors.initials: Y
authors.lastname: Sugawara
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Sadanori
authors.initials: S
authors.lastname: Okada
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Taku
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Department of Regulatory Medicine for Blood Pressure, Nara Medical University, Kashihara, Nara, Japan (K.O., Y.S.).
authors.forename: Kenji
authors.initials: K
authors.lastname: Onoue
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okayama
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Yukiji
authors.initials: Y
authors.lastname: Takeda
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawata
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.).
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (T.U., R.K., Y.S., S.O., T.N., T.S., S.O., Y.T., M.W., H.K., S.U., Y.S.) Department of Regulatory Medicine for Blood Pressure, Nara Medical University, Kashihara, Nara, Japan (K.O., Y.S.).
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010351:Patient Discharge; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain; D003404:Creatinine
keywords: acute decompensated heart failure; prognosis; worsening of renal function after discharge