March 14, 2018Journal of the American Heart Association41 citationsOpen Access
Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry
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Key Result
Worsening renal function during admission independently predicted 1-year mortality in both HFrEF (HR 1.41; 95% CI 1.12-1.78) and HFpEF (HR 1.72; 95% CI 1.23-2.42).
Study Design
Type
Cohort (n=5,625)
Multicenter
Yes
Structured PICO
Does worsening renal function during admission predict adverse outcomes in patients with acute heart failure (HFpEF vs HFrEF)?
P
Population
5,625 patients with acute heart failure from the KorAHF registry, evaluated for the prognostic value of worsening renal function over 1 year.
E
Exposure
Worsening renal function (WRF) during admission (defined as an absolute increase in creatinine of ≥0.3 mg/dL)
C
Comparator
No worsening renal function
O
Outcome
Adverse in-hospital outcomes and 1-year mortalityhard clinical
Worsening renal function during acute heart failure admission independently predicts adverse in-hospital outcomes and 1-year mortality in both HFrEF and HFpEF patients.
Main Result
Hazard Ratio: 1.41 (95% CI 1.12–1.78)
p-value: p=0.004
Abstract
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.