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).
Cohort (n=5,625)
Yes
Does worsening renal function during admission predict adverse outcomes in patients with acute heart failure (HFpEF vs HFrEF)?
Worsening renal function during acute heart failure admission independently predicts adverse in-hospital outcomes and 1-year mortality in both HFrEF and HFpEF patients.
Hazard Ratio: 1.41 (95% CI 1.12–1.78)
p-value: p=0.004
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.
Kang et al. (2018) conducted a cohort in Acute Heart Failure (n=5,625). Worsening renal function (WRF) vs. No WRF was evaluated on 1-year mortality in HFrEF (HR 1.41, 95% CI 1.12-1.78, p=0.004). 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).