title: Outcome in acute heart failure: prognostic value of acute kidney injury and worsening renal function.
abstract: BACKGROUND
  The prognostic value of worsening renal function (WRF) in acute heart failure is debated. Moreover, it is not clear if the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this context is detrimental.
  
  
  RESULTS
  In a retrospective cohort study of 646 patients hospitalized for acute heart failure, the risk of death or readmission associated with acute kidney injury (AKI) present at admission, WRF during the 1st 7 days, and up-titration of ACEI/ARB were analyzed in a Cox proportional hazards model. AKI, WRF, hemoglobin concentration, ACEI/ARB up-titration, and use of loop diuretics before admission were significantly associated with the primary outcome in univariate analysis. In a multivariate model, the association remained significant for AKI (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13-1.47; P = .0002), WRF (HR 1.24, 95% CI 1.06-1.45; P = .0059), and ACEI/ARB up-titration (HR 0.79, 95% CI 0.64-0.97; P = .026). There was no excess mortality in patients with ACEI/ARB up-titration despite WRF.
  
  
  CONCLUSIONS
  Both AKI and WRF are strongly associated with poor outcome in patients hospitalized for acute heart failure. ACEI/ARB up-titration seems to be protective.
authors.affiliation: Division of Internal Medicine, Internal Medecine and Rehabilitation Department, Geneva University Hospitals, Geneva, Switzerland. Electronic address: gregory.berra@hcuge.ch.
authors.forename: Gregory
authors.initials: G
authors.lastname: Berra
authors.affiliation: Division of Internal Medicine, Medecine Department, Chablais Regional Hospital, Monthey, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Garin
authors.affiliation: Division of Internal Medicine, Internal Medecine and Rehabilitation Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Stirnemann
authors.affiliation: Division of Epidemiology, Quality and Medical Direction Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Jannot
authors.affiliation: Division of Nephrology, Medical Specialties Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Martin
authors.affiliation: Division of Internal Medicine, Internal Medecine and Rehabilitation Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.affiliation: Division of Internal Medicine, Internal Medecine and Rehabilitation Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Carballo
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007677:Kidney Function Tests / Q000639:trends*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: ACEI/ARB up-titration; Worsening renal function; acute heart failure; death; prognosis; readmission