title: The Prognostic Importance of Changes in Renal Function during Treatment for Acute Heart Failure Depends on Admission Renal Function.
abstract: BACKGROUND
  Worsening and improving renal function during acute heart failure have been associated with adverse outcomes but few studies have considered the admission level of renal function upon which these changes are superimposed.
  
  
  OBJECTIVE
  The objective of this study was to evaluate definitions that incorporate both admission renal function and change in renal function.
  
  
  METHODS
  696 patients with acute heart failure with calculable eGFR were classified by admission renal function (Reduced [R, eGFR<45 ml/min] or Preserved [P, eGFR≥45 ml/min]) and change over hospital admission (worsening [WRF]: eGFR ≥20% decline; stable [SRF]; and improving [IRF]: eGFR ≥20% increase). The primary outcome was all-cause mortality. The prevalence of Pres and Red renal function was 47.8% and 52.2%. The frequency of R-WRF, R-SRF, and R-IRF was 11.4%, 28.7%, and 12.1%, respectively; the incidence of P-WRF, P-SRF, and P-IRF was 5.7%, 35.3%, and 6.8%, respectively. Survival was shorter for patients with R-WRF compared to R-IRF (median survival times 13.9 months (95%CI 7.7-24.9) and 32.5 months (95%CI 18.8-56.1), respectively), resulting in an acceleration factor of 2.3 (p = 0.016). Thus, an increase compared with a decrease in renal function was associated with greater than two times longer survival among patients with Reduced renal function.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Reid
authors.affiliation: Division of Cardiology, University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Brown
authors.affiliation: Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Canada; Division of General Internal Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Canada; School of Public Health, University of Alberta, Edmonton, Canada.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada; Department of Physiology, University of Alberta, Edmonton, Canada.
authors.forename: Branko
authors.initials: B
authors.lastname: Braam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis