title: Transient and persistent worsening renal function during hospitalization for acute heart failure.
abstract: BACKGROUND
  Transient and persistent worsening renal function (WRF) may be associated with different risks during hospitalization for acute heart failure. We compared outcomes of patients hospitalized for acute heart failure with transient, persistent, or no WRF.
  
  
  METHODS
  We identified patients 65 years or older hospitalized with acute heart failure from a clinical registry linked to Medicare claims data. We defined WRF as an increase in serum creatinine of ≥ 0.3 mg/dL after admission. We further classified patients with WRF by the difference between admission and last recorded serum creatinine levels into transient WRF (< 0.3 mg/dL) or persistent WRF (≥ 0.3 mg/dL). We examined unadjusted rates and adjusted associations between 90-day outcomes and WRF status.
  
  
  RESULTS
  Among 27,309 patients, 18,568 (68.0%) had no WRF, 3,205 (11.7%) had transient WRF, and 5,536 (20.3%) had persistent WRF. Patients with WRF had higher observed rates of 90-day postdischarge all-cause readmission and 90-day postadmission mortality (P < .001). After multivariable adjustment, transient WRF (hazard ratio [HR] 1.19, 99% CI 1.05-1.35) and persistent WRF (HR 1.73, 99% CI 1.57-1.91) were associated with higher risks of 90-day postadmission mortality (P < .001 for both). Compared with transient WRF, persistent WRF was associated with a higher risk of 90-day postadmission mortality (HR 1.46, 99% CI 1.28-1.66, P < .001).
  
  
  CONCLUSIONS
  Transient and persistent WRF during hospitalization for acute heart failure were associated with higher adjusted risks for 90-day all-cause postadmission mortality. Patients with persistent WRF had worse outcomes.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Arun
authors.initials: A
authors.lastname: Krishnamoorthy
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Greiner
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ.
authors.forename: Puza P
authors.initials: PP
authors.lastname: Sharma
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ.
authors.forename: Katherine Waltman
authors.initials: KW
authors.lastname: Johnson
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC. Electronic address: adrian.hernandez@duke.edu.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000208:Acute Disease; D000368:Aged; D003404:Creatinine / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D003404:Creatinine