title: Interaction between worsening renal function and persistent congestion in acute decompensated heart failure.
abstract: Worsening renal function (WRF) and congestion are inextricably related pathophysiologically, suggesting that WRF occurring in conjunction with persistent congestion would be associated with worse clinical outcome. We studied the interdependence between WRF and persistent congestion in 762 patients with acute decompensated heart failure (HF). WRF was defined as ≥0.3 mg/dl increase in serum creatinine above baseline at any time during hospitalization and persistent congestion as ≥1 sign of congestion at discharge. The primary end point was all-cause mortality with mean follow-up of 15 ± 9 months. Readmission for HF was a secondary end point. Persistent congestion was more common in patients with WRF than in patients with stable renal function (51.0% vs 26.6%, p <0.0001). Both persistent congestion and persistent WRF were significantly associated with mortality (both p <0.0001). There was a strong interaction (p = 0.003) between persistent WRF and congestion, such that the increased risk for mortality occurred predominantly with both WRF and persistent congestion. The adjusted hazard ratio for mortality in patients with persistent congestion as compared with those without was 4.16 (95% confidence interval [CI] 2.20 to 7.86) in patients with WRF and 1.50 (95% CI 1.16 to 1.93) in patients without WRF. In conclusion, persisted congestion is frequently associated with WRF. We have identified a substantial interaction between persistent congestion and WRF such that congestion portends increased mortality particularly when associated with WRF.
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Malak
authors.initials: M
authors.lastname: Wattad
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Wisam
authors.initials: W
authors.lastname: Darawsha
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Solomonica
authors.affiliation: Department of Internal Medicine D, Rambam Medical Center, Haifa, Israel.
authors.forename: Maher
authors.initials: M
authors.lastname: Hijazi
authors.affiliation: The Laboratory of Clinical Biochemistry, Department of Physiology and Biophysics, Rambam Medical Center, Haifa, Israel.
authors.forename: Marielle
authors.initials: M
authors.lastname: Kaplan
authors.affiliation: Department of Internal Medicine B, Rambam Medical Center, Haifa, Israel.
authors.forename: Badira F
authors.initials: BF
authors.lastname: Makhoul
authors.affiliation: Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Zaid A
authors.initials: ZA
authors.lastname: Abassi
authors.affiliation: Department of Internal Medicine B, Rambam Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Zaher S
authors.initials: ZS
authors.lastname: Azzam
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel. Electronic address: daronson@tx.technion.ac.il.
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
mesh_terms: D000208:Acute Disease; D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D051437:Renal Insufficiency / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends