Clinical Impact of Worsening Renal Function in Patients with Acute Decompensated Heart Failure
Abstract
Abstract
Background: The population of aging patients with heart failure (HF) is
rapidly increasing, especially in developed countries. Aging causes
structural and functional changes to the cardiovascular system and
organs, including the heart and kidneys. The clinical significance of
worsening renal function (WRF) in patients with acute decompensate heart
failure (ADHF) is not completely understood.
Objective: To assess the Clinical Impact of Worsening Renal Function in
Patients with Acute Decompensated Heart Failure.
Methods: The prospectively observational cohort study was conducted in
the Department of Cardiology, Enam Medical College & Hospital, Savar,
Bangladesh between January 2019 to Jun 2020. A retrospective analysis of
data on 200 consecutive patients admitted with ADHF was carried out. By
definition, WRF occurred when the serum creatinine level increased during
hospitalization by 0.3 mg/dL and by 25% from admission.
Results. Overall, 23% of patients developed WRF. On multivariate
analysis, age >70 years (odds ratio [OR] = 2.72; 95% confidence inter-val
[CI], 1.86-3.42), admission glomerular filtration rate <60 mL/min per 1.73
m2 (OR=2.05; 95% CI, 1.53-2.27) and admission systolic pressure <90
mm Hg (OR=1.61; 95% CI, 1.17-3.22) were indepen-dently associated
with WRF. The rate of mortality or readmission for heart failure (HF) at 1
year was higher in the WRF group (P<.01 by log-rank test). The
median hospital stay was 9 days for patients with WRF and 4 days for
those without (P<.05). On multivariate analysis, WRF remained
independently associated with mortality or HF rehospitalization (hazard ratio
= 1.65; 95% CI, 1.12-2.67; P=.003).
Conclusions: In patients admitted for ADHF, WRF was a common
complication and was associated with a longer hospital stay and an increased
risk of mortality or HF hospitalization. Clinical characteristics at admission
can help identify patients at an increased risk of WRF. The primary endpoint
was a composite of cardiac events within 1 year. The patients in the over-70,
WRF group presented more significant mean blood pressure (MBP) drops
than those in the over-70 non- WRF group (p=0.003). Logistic regression
analyses revealed that higher MBP at admission was a significant predictor
of WRF.