Key result
Worsening renal function before acute heart failure admission linked to ~256% higher in-hospital mortality.
Why the study?
The incidence and timing of worsening renal function in patients hospitalized for heart failure and treated with intravenous diuretics in Japan needed investigation.
Does the timing of worsening renal function (before vs. after admission) affect in-hospital mortality in patients hospitalized for acute heart failure treated with intravenous diuretics?
Observational (n=1,788)
Yes
Does the timing of worsening renal function (before vs. after admission) affect in-hospital mortality in patients hospitalized for acute heart failure treated with intravenous diuretics?
Worsening renal function frequently occurs prior to hospital admission for acute heart failure and is associated with a similarly high risk of in-hospital mortality as worsening renal function that develops after admission.
Answers are grounded in this paper and cite their sources.
Pre-admission worsening renal function identifies high-risk acute heart failure patients; hypothesis-generating for early interventions, should not yet change practice.
BACKGROUND: This retrospective observational study investigated the incidence of worsening renal function (WRF) in patients hospitalized for heart failure (HF) and treated with intravenous diuretics in Japan. METHODS AND RESULTS: Associations between WRF at any point and HF treatments, and the effects of WRF on outcomes were evaluated (Diagnosis Procedure Combination database). Of 1,788 patients analyzed (mean [±SD] age 80.5±10.2 years; 54.4% male), 641 (35.9%) had WRF during a course of hospitalization for worsening HF: 208 (32.4%) presented with WRF before admission (BA-WRF; estimated glomerular filtration rate decreased by ≥25% from baseline at least once between 30 days prior to admission and admission); 44 (6.9%) had WRF that persisted before and after admission (P-WRF); and 389 (60.7%) had WRF develop after admission (AA-WRF). Delayed initial diuretic administration, higher maximum doses of intravenous diuretics during hospitalization, and diuretic readministration during hospitalization were associated with a significantly higher incidence of AA-WRF. Patients with WRF at any time point were at higher risk of death during hospitalization compared with patients without WRF, with adjusted hazard ratios of 3.56 (95% confidence interval [CI] 2.23-5.69) for BA-WRF, 3.23 (95% CI 2.21-4.71) for AA-WRF, and 13.16 (95% CI 8.19-21.15) for P-WRF (all P<0.0001). CONCLUSIONS: Forty percent of WRF occurred before admission for acute HF; there was no difference in mortality between patients with BA-WRF and AA-WRF.
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Shiraishi et al. (2023) conducted an observational in Heart failure exacerbation (n=1,788). Worsening renal function before admission (BA-WRF) vs. No worsening renal function (non-WRF) was evaluated on In-hospital death (HR 3.56, 95% CI 2.23-5.69, p=<0.0001). Worsening renal function before admission for acute heart failure was associated with a significantly higher risk of in-hospital death compared to no worsening renal function (HR 3.56).
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