Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 46; no. 1; pp. 57 - 66
• Main Authors: Lee, Hao‐Wei, Huang, Chin‐Chou, Yang, Chih‐Yu, Leu, Hsin‐Bang, Huang, Po‐Hsun, Wu, Tao‐Cheng, Lin, Shing‐Jong, Chen, Jaw‐Wen
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-01-2023; John Wiley and Sons Inc
• Subjects: acute decompensated heart failure; Beta blockers; Body mass index; Cardiac arrhythmia; Cardiovascular disease; cardiovascular event; Clinical Investigations; Clinical outcomes; Creatinine; Diabetes; Diuretics; East Asian People; Ejection fraction; Enzymes; Glomerular Filtration Rate; Heart attacks; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - therapy; High density lipoprotein; Hospitalization; Humans; Hyperlipidemia; Hypertension; Kidney - physiology; Kidney diseases; Laboratories; Mortality; Patients; Peptides; Prognosis; renal function; Retrospective Studies; Statistical analysis; Survival analysis; worsening renal function; acute decompensated heart failure; renal function; worsening renal function; hospitalization; cardiovascular event
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.23934

Background
The heart and kidneys had demonstrated a bidirectional interaction that dysfunction of the heart or kidneys can induce dysfunction in the other organ.
Hypothesis
Renal function and its decline during hospitalization may have impact on cardiovascular outcomes in patients with acute decompensated heart failure (ADHF).
Methods
A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four‐variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF) was defined as eGFR decline between admission (eGFRadmission) and predischarge (eGFRpredischarge). Clinical outcomes were defined as 4P‐major adverse cardiovascular events (4P‐MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization.
Results
During an average 2.6 ± 3.2 years follow‐up, 66 patients (55%) experienced 4P‐MACE. Patients with impaired eGFRpredischarge (<60 ml/min/1.73 m2) had more 4P‐MACE than those with preserved eGFRpredischarge (64.7% vs. 43.1%, p = .019). The Kaplan–Meier survival curves showed significantly higher incidence of 4P‐MACE in patients with impaired eGFRpredischarge than those with preserved eGFRpredischarge (p = .002). Cox regression analysis revealed that impaired eGFRpredischarge was significantly correlated with the development of 4P‐MACE (hazard ratio, 2.003; 95% confidence interval, 1.072–3.744; p = .029). In contrast, outcomes would be similar with regard to eGFR on admission and eGFR decline during hospitalization.
Conclusions
Impaired renal function before discharge, but not impaired renal function on admission or WRF, is a significant risk factor for poor outcomes in patients with ADHF.