Abstract 812: Renal Function And Acute Heart Failure: A Substudy From Alarm-hf
The prevalence of renal dysfunction and risk factors associated with worsening renal function in patients hospitalized with acute heart failure remains poorly characterized. The study was conducted as a retrospective in-hospital observational survey, via a questionnaire, from 744 hospitals, including 5–8 consecutive admissions each, in 10 countries over the period from October 2006-March 2007. Data from 4845 patients with evaluations on renal function were included. In this population we analyzed renal function at admission, the presence and associated risk factors of worsening of renal function (logistic regression) and mortality. At admission 66,4% had normal or mild renal dysfunction (Serum creatinine SCr ≤ 1,5 mg/dL), 24,3% had moderate renal dysfunction (SCr > 1,5 and ≤ 2,5 mg/dL) and 9,3% had severe renal dysfunction (SCr > 2,5 mg/dL). In-hospital mortality according to these groups were 9,1%, 14,8% and 29,8% respectively, p <,001. Renal function worsening, defined as the in-hospital increase of SCr > 20%, was present in 26,9%. In-hospital mortality in this group was 17,5%. By contrast, mortality in patients without changes in renal function or improving was 4,36%, p <,001. Independent risk factors associated with renal function worsening during admission were: age (OR 0,91 CI 0,869–0,971), body mass index (OR 1,03 CI: 1,007–1,069), coronary artery disease (OR 1,398 CI: 1,039–1,883), baseline renal dysfunction (OR 1,4 CI: 1,22–1,60), anemia (OR 1,605 CI: 1,062–2,427) and the use of an ACE inhibitor (OR 1,41 CI: 1,060–1,881), p < 0.05 for all independent risk factors. A third of the patients admitted for acute heart failure have significant renal impairment which influences outcomes. Renal function deterioration during hospitalization increases in-hospital mortality. Age, higher body mass index, presence of coronary artery disease, baseline renal dysfunction, anemia and the use of an ACE inhibitor are independent risk factors associated with renal function worsening.