Key result
Admission renal dysfunction is linked to ~6-fold higher in-hospital mortality, but not mid-term MACE.
Why the study?
Renal dysfunction at admission in patients hospitalised for AHF is traditionally linked to adverse prognosis, but whether it identifies a distinct and clinically more severe phenotype beyond long-term outcomes required further characterisation.
Does renal dysfunction at admission (eGFR <60 mL/min/1.73m²) increase in-hospital mortality and mid-term major adverse cardiovascular events in patients hospitalised for acute heart failure?
Observational (n=446)
No
Does renal dysfunction at admission (eGFR <60 mL/min/1.73m²) increase in-hospital mortality and mid-term major adverse cardiovascular events in patients hospitalised for acute heart failure?
In acute heart failure, admission renal dysfunction (eGFR <60 mL/min/1.73m²) identifies a phenotype with greater comorbidity burden, acute haemodynamic instability, and higher in-hospital mortality, but does not result in worse mid-term MACE.
Admission eGFR <60 signals higher in-hospital mortality in acute HF; leaves open its utility for mid-term MACE risk stratification.
Introduction Renal dysfunction is common in patients hospitalised for acute heart failure (AHF) and has traditionally been associated with adverse prognosis. However, beyond long-term outcomes, impaired renal function at admission may identify a distinct and clinically more severe phenotype. This study aimed to compare baseline characteristics, clinical presentation, and outcomes according to renal function at admission. Methods This retrospective observational study included 446 consecutive patients admitted to a heart failure programme between 2019 and 2025. Patients were stratified according to estimated glomerular filtration rate (eGFR) at admission (≥60 vs <60 mL/min/1.73m²). Baseline clinical, laboratory, and echocardiographic variables were analysed. Markers of acute severity and in-hospital mortality were recorded. Follow-up included major adverse cardiovascular events (MACE), defined as cardiovascular death or HF rehospitalisation. Survival analysis was performed using Kaplan–Meier curves and log-rank testing. Results Patients with eGFR <60 (n=225) were older (78 [73–83] vs 75 [64–80] years; p<0.001) and had a higher comorbidity burden (Charlson index 7 [5–9] vs 5 [4–6]; p<0.001). Hypertension (85% vs 71%; p<0.001), diabetes (59% vs 42%; p<0.001), dyslipidaemia (65% vs 52%; p=0.003), cerebrovascular disease (23% vs 9%; p<0.001), chronic kidney disease (59% vs 2.3%; p<0.001), and previously diagnosed HF (53% vs 28%; p<0.001) were more frequent. Pre-admission loop diuretic use was significantly higher (59% vs 34%; p<0.001). Laboratory differences included lower haemoglobin (11.9 [10–13] vs 13.2 [12–14] g/dL; p<0.001) and higher BNP levels at admission (9290 [3553–16796] vs 4896 [1858–5707] pg/mL; p<0.001). LVEF did not differ between groups (45 [30–60] vs 40 [31–60]%; p=0.941). Renal dysfunction was associated with a more severe acute presentation, including higher rates of acute pulmonary oedema (13% vs 8%; p=0.037), low cardiac output (13% vs 5%; p=0.002), diuretic resistance (16% vs 6%; p<0.001), severe pulmonary hypertension (23% vs 9%; p<0.001), right ventricular dysfunction (33% vs 23%; p=0.016), and in-hospital mortality (3% vs 0.5%; p=0.036). Despite this more unstable clinical profile, Kaplan–Meier analysis showed no significant differences in mid-term MACE between groups (log-rank p=0.401). Conclusion In patients hospitalised for acute heart failure, renal dysfunction at admission, frequently reflecting underlying chronic kidney disease, identified a phenotype characterised by advanced comorbidity, greater haemodynamic instability, and higher in-hospital mortality, without translating into worse mid-term outcomes.Table 1Figure 1
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Asua et al. (2026) conducted an observational in Acute heart failure (n=446). Renal dysfunction at admission (eGFR <60 mL/min/1.73m²) vs. eGFR >=60 mL/min/1.73m² at admission was evaluated on Major adverse cardiovascular events (MACE), defined as cardiovascular death or HF rehospitalisation, and in-hospital mortality (p=0.036 for in-hospital mortality; log-rank 0.401 for mid-term MACE). Renal dysfunction at admission (eGFR <60) was associated with higher in-hospital mortality (3% vs 0.5%; p=0.036) but showed no significant difference in mid-term MACE (log-rank p=0.401).
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