Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry

Background Worsening renal function ( WRF ) is associated with adverse outcomes in patients with heart failure. We investigated the predictors and prognostic value of WRF during admission, in patients with preserved ejection fraction ( HF p EF ) versus those with reduced ejection fraction ( HF r EF ). Methods and Results A total of 5625 patients were enrolled in the KorAHF (Korean Acute Heart Failure) registry. WRF was defined as an absolute increase in creatinine of ≥0.3 mg/ dL . Transient WRF was defined as recovery of creatinine at discharge, whereas persistent WRF was indicated by a nonrecovered creatinine level. HF p EF and HF r EF were defined as a left ventricle ejection fraction ≥50% and ≤40%, respectively. Among the total population, WRF occurred in 3101 patients (55.1%). By heart failure subgroup, WRF occurred more frequently in HF r EF (57.0% versus 51.3%; P <0.001 in HF r EF and HF p EF ). Prevalence of WRF increased as creatinine clearance decreased in both heart failure subgroups. Among various predictors of WRF , chronic renal failure was the strongest predictor. WRF was an independent predictor of adverse in‐hospital outcomes ( HF r EF : odds ratio; 2.75; 95% confidence interval, 1.50–5.02; P =0.001; HF p EF : odds ratio, 9.48; 95% confidence interval, 1.19–75.89; P =0.034) and 1‐year mortality ( HF r EF : hazard ratio, 1.41; 95% confidence interval , 1.12–1.78; P =0.004 versus HF p EF : hazard ratio, 1.72; 95% confidence interval, 1.23–2.42; P =0.002). Transient WRF was a risk factor for 1‐year mortality, whereas persistent WRF had no additive risk compared to transient WRF . Conclusions In patients with acute heart failure patients, WRF is an independent predictor of adverse in‐hospital and follow‐up outcomes in both HF r EF and HF p EF , though with a different effect size. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 01389843.