Acute heart failure patients with eGFR <60 had 1.54-fold higher risk of hospitalization or CV death (13.7% vs 10.5%; AHR 1.54, P=0.004), worsened by obesity, diabetes, AF.
Does baseline renal impairment (eGFR <60 ml/min/1.73 m2) increase the risk of heart failure hospitalization or cardiovascular death in patients hospitalized for acute heart failure?
In patients hospitalized for acute heart failure, baseline renal impairment (eGFR <60 ml/min/1.73m2) is significantly associated with an increased risk of cardiovascular death and heart failure readmission.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Kidney disease as a high risk of comorbidity of heart failure frequently causes a vicious cycle of cardiorenal deterioration and results in critically adverse outcome in patients with acute heart failure. We planned to analyze and assess cardiovascular and kidney complications of the patients with acute heart failure according to renal function. Purpose We aimed to evaluate the severity and prognosis of the patients with renal impairment following acute heart failure in the real world. Methods We conducted a cohort study at 9 university hospitals and enrolled 1784 patients hospitalized for acute heart failure from September 2019 to December 2023. Patients were divided into two groups based on an estimated glomerular filtration rate (eGFR), indirectly indicating renal function. One had an eGFR of at least 60 ml per minute per 1.73 m2 of body-surface area showing above normal and mildly decreased renal function, the other had an eGFR of less than 60 ml/min/1.73 m2 including more significant renal impairment. The primary outcome was the rate of hospitalization from heart failure or death from cardiovascular causes. Results Of 1784 patients with mean age 69.0±15.1 years and 41.4% female, 663 patients (37.2%) had an eGFR 60 ml/min/1.73 m2 and 1121 patients (62.8%) had an eGFR ≥ 60 ml/min/1.73 m2. During a median of 1 year of follow-up, the rate of hospitalization from heart failure and death from cardiovascular causes occurred in 127 of 663 patients (13.7%) in the eGFR 60 ml/min/1.73m2 group and in 118 of 1121 (10.5%) in the eGFR ≥60 ml/min/1.73m2 group (adjusted hazard ratio AHR, 1.54; 95% confidence interval CI, 1.15 to 2.08; P = 0.004). The risk was higher, when combined with obesity (AHR, 1.91; 95% CI, 1.17 to 3.11; P = 0.009), diabetes (AHR, 1.81; 95% CI, 1.18 to 2,78; P = 0.007), atrial fibrillation and atrial flutter (AHR, 1.96; 95% CI, 1.15 to 3.32; P = 0.013), however, the risk of difference by left ventricular ejection fraction was insignificant. Progressive renal disease, defined decrease in eGFR of ≥40% from baseline or newly developed eGFR 15 ml/min/1.73m2 happened in 67 of 663 (10.1%) in the eGFR 60 ml/min/1.73m2 group and in 101 of 1121 (9%) in the eGFR ≥60 ml/min/1.73m2 group (AHR, 0.7; 95% CI, 0.48 to 1.01; P = 0.058). Other secondary outcomes were poorer in the eGFR 60 ml/min/1.73m2 group than the eGFR ≥60 ml/min/1.73m2 group (all-cause mortality: AHR, 1.84; 95% CI, 1.07 to 3.16; P = 0.028; all-cause readmission: AHR, 1.38; 95% CI, 1.13 to 1.69; P = 0.002). Conclusions More impaired renal function was closely associated with worse overall prognosis of cardiovascular and renal disease in patients admitted for acute heart failure, especially, the risk of cardiorenal complication was more increased with obesity, diabetes, atrial fibrillation and atrial flutter. Additional study about medication for the patients with co-existing heart failure and renal insufficiency is needed.
Lim et al. (Sat,) reported a other. Acute heart failure patients with eGFR <60 had 1.54-fold higher risk of hospitalization or CV death (13.7% vs 10.5%; AHR 1.54, P=0.004), worsened by obesity, diabetes, AF.