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Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance
Author(s) -
Metra Marco,
Nodari Savina,
Parrinello Giovanni,
Bordonali Tania,
Bugatti Silvia,
Danesi Rossella,
Fontanella Benedetta,
Lombardi Carlo,
Milani Patrizia,
Verzura Giulia,
Cotter Gadi,
Dittrich Howard,
Massie Barry M.,
Cas Livio Dei
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.01.011
Subject(s) - medicine , heart failure , ejection fraction , renal function , furosemide , cardiology , creatinine , clinical significance , logistic regression , acute kidney injury
Background: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF). Methods and results: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a ≥25% and a ≥0.3 mg/dL increase in serum creatinine (s‐Cr) from admission (WRF‐Abs‐%). Results: Patients were followed for 480±363 days. Fifty‐three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF‐Abs‐% occurred in 107 (34%) patients. At multivariable survival analysis, WRF‐Abs‐% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13–1.81; p =0.024). The independent predictors of WRF‐Abs‐%, evaluated using multivariable logistic regression, were history of chronic kidney disease ( p =0.002), LV ejection fraction ( p =0.012), furosemide daily dose ( p =0.03) and NYHA class ( p =0.05) on admission. Conclusion: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.