© 2008 European Society of Cardiology
Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance
a Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia Italy
b Section of Medical Statistics, Department of Medical Sciences and Biotechnology, University of Brescia Italy
c Momentum-Research Durham, NC, USA
d NovaCardia Inc. San Diego, Ca, USA
e Cardiology Division, University of California and the Department of Veterans Affairs Medical Center San Francisco, Ca, USA
* Corresponding author. Cattedra di Cardiologia, c/o Spedali Civili, Piazza Spedali Civili, 25100 Brescia, Italy. Tel.: +39 030 3995573; fax: +39 030 3700359. E-mail address: metramarco{at}libero.it (M. Metra).
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Abstract |
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Background: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF).
Methods and results: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a 
25% and a 0.3 mg/dL increase in serum creatinine (s-Cr) from admission (WRF-Abs-%).
Results: Patients were followed for 480±363 days. Fifty-three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF-Abs-% occurred in 107 (34%) patients. At multivariable survival analysis, WRF-Abs-% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13–1.81; p=0.024). The independent predictors of WRF-Abs-%, evaluated using multivariable logistic regression, were history of chronic kidney disease (p=0.002), LV ejection fraction (p=0.012), furosemide daily dose (p=0.03) and NYHA class (p=0.05) on admission.
Conclusion: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.
Key Words: Acute heart failure • Renal function • Prognosis
Received September 29, 2007; Revised January 12, 2008; Accepted January 21, 2008
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