What is the clinical evidence from this study?

Study design: Systematic Review. Population: Acute heart failure and cardiorenal syndrome type 1 (n=10107). Intervention: Residual congestion vs. Successful decongestion. Primary outcome: Clinical and renal outcomes (narrative synthesis).

September 15, 2026CureusOpen Access

Renal Dysfunction and Cardiorenal Syndrome in Acute Heart Failure: A Systematic Review of Residual Congestion and Decongestion Response

Q: What does this research mean for the field?

In acute heart failure, residual congestion is consistently associated with worse clinical outcomes, whereas worsening renal function during effective decongestion does not uniformly predict adverse events. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Residual congestion predicts worse outcomes, but worsening renal function during effective decongestion does not.

n=10,107

Why the study?

The prognostic significance of worsening renal function in acute heart failure depends on clinical context, particularly residual congestion and decongestion response, but contemporary evidence is limited.

Does decongestion response and residual congestion affect clinical and renal outcomes in adults hospitalized with acute heart failure or cardiorenal syndrome type 1?

Comparison

Worsening renal function and residual congestion versus no worsening renal function or successful decongestion

Design

Systematic review of randomized controlled trials and trial-derived analyses

Authors

AHAbdul HannanFederal Office of Meteorology and Climatology MeteoSwiss AHAbul Kashem HimonThe Rotherham NHS Foundation Trust SSSarah SinghVita-Salute San Raffaele University

Discussion

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Implication

The prognostic significance of worsening renal function in acute heart failure depends heavily on whether effective decongestion is achieved, supporting a shift toward an integrated renal-congestion framework.

Key Points

To evaluate contemporary evidence regarding the relationships among renal dysfunction, residual congestion, decongestion response, and clinical outcomes in hospitalized acute heart failure or cardiorenal syndrome type 1.
Systematic search of PubMed/MEDLINE, Scopus, and Web of Science for studies published between January 1, 2021, and December 31, 2025.
Included 5 studies (randomized controlled trials, prespecified analyses, and post hoc analyses; sample sizes ranging from 48 to 5,900 participants) evaluating both renal and congestion-related outcomes.
Assessed risk of bias using RoB 2 for randomized interventions and ROBINS-I for non-randomized exposure-based comparisons.
Residual congestion at day 5 independently increased 180-day risk of cardiovascular death or heart failure/renal failure rehospitalization for a composite congestion score (CCS) ≥1 (adjusted HR 1.32, 95% CI 1.15–1.51; p < 0.001) and CCS ≥3 (adjusted HR 1.62, 95% CI 1.39–1.88; p < 0.001).
In the ADVOR trial analysis, worsening renal function occurred more frequently with acetazolamide (40.5% vs 18.9%; p < 0.001), yet successful decongestion predicted improved outcomes regardless of renal function changes.
VExUS-guided decongestion achieved greater decongestion (OR 2.6, 95% CI 1.9–3.0; p = 0.01) and higher rates of BNP reduction >30% (OR 2.4, 95% CI 1.3–4.1; p = 0.01) compared with usual clinical evaluation without altering kidney function recovery.

Study Design

Type

Systematic Review (n=10,107)

Structured PICO

Does decongestion response and residual congestion affect clinical and renal outcomes in adults hospitalized with acute heart failure or cardiorenal syndrome type 1?

Population

A systematic review of 5 studies comprising 10,107 adults hospitalized with acute heart failure or cardiorenal syndrome type 1, evaluating the prognostic significance of residual congestion and decongestion response.

Exposure

Worsening renal function, baseline renal dysfunction, residual congestion, decongestion response, and the use of objective congestion-guided strategies (VExUS, bioimpedance).

Comparator

Patients without worsening renal function, those receiving usual care, those achieving successful versus incomplete decongestion, and groups stratified by renal function or congestion status.

Outcome

Kidney function recovery, worsening renal function, acute kidney injury, long-term decline in kidney function, residual congestion, successful decongestion, heart failure or renal failure rehospitalization, cardiovascular and all-cause mortality, and composite clinical outcomes.

Limitations

Only five studies met the eligibility criteria, limiting the breadth and certainty of the evidence.
Substantial clinical and methodological heterogeneity across included studies.
Synthesis combined randomized intervention effects with findings from post hoc and prognostic analyses.
19 reports could not be retrieved, potentially introducing selection bias.
Heterogeneity prevented quantitative pooling and meta-analysis.
Clinical and methodological heterogeneity across studies
Residual confounding in post hoc analyses because congestion status and the rate of decongestion were not randomized

Cite This Study

Hannan et al. (2026) conducted a systematic review in Acute heart failure and cardiorenal syndrome type 1 (n=10,107). Residual congestion vs. Successful decongestion was evaluated on Clinical and renal outcomes (narrative synthesis). Residual congestion was consistently associated with worse clinical outcomes, whereas worsening renal function during effective decongestion did not uniformly predict adverse renal or cardiovascular events.

synapsesocial.com/papers/6aa9016aeed42882c1fc1820 https://doi.org/10.7759/cureus.116198

Topics

Heart failure HFrEF treatment

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Renal Dysfunction and Cardiorenal Syndrome in Acute Heart Failure: A Systematic Review of Residual Congestion and Decongestion Response

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Renal Dysfunction and Cardiorenal Syndrome in Acute Heart Failure: A Systematic Review of Residual Congestion and Decongestion Response

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

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