Abstract 1350: Reversibility of Worsened Renal Function During Acute Heart Failure Hospitalization and Association With Subsequent Outcomes
Background: Worsened renal function (WRF) during heart failure (HF) hospitalization is associated with increased mortality and re-hospitalization. However, many patients with WRF recover before discharge, and whether patients with transient vs. persistent WRF have similar outcomes is not known.
Methods: This was a retrospective cohort study of patients who received care from a large health system in southeast Michigan and had a primary hospital discharge diagnosis of HF between 1/1/2000 and 6/30/2008. Patients with end-stage renal disease were excluded. Renal function during index hospitalization was assessed using serial creatinine (Cr) values. The first Cr value during hospitalization was considered baseline. WRF was defined as ≥0.3mg/dl increase in Cr on any subsequent day compared to baseline. Persistence was defined as the subject meeting the WRF definition at the last available Cr during hospitalization. Proportional hazards regression was used to assess the relationship of WRF category (none, transient, or persistent) with mortality and re-hospitalization following discharge. Median follow up was 2 years. Covariates included age, race, gender, baseline Cr, atrial fibrillation, diabetes, hypertension, vascular disease, stroke, heart failure, and coronary disease.
Results: Among the 2537 patients meeting inclusion criteria, 49.1% were female, 50.6% were African American, and average baseline Cr was 1.36 mg/dl. Overall, 931 (36.2%) patients developed WRF. Of these, 566 (61%) had persistent WRF while 365 (39%) had transient WRF. After adjustment for baseline covariates, persistent WRF was independently associated with increased mortality (HR 1.24 95%CI 1.09–1.42) and re-hospitalization (HR 1.14 95%CI 1.02–1.27). In contrast, transient WRF was not a significant predictor of mortality (HR 1.08 95%CI 0.92–1.27) nor re-hospitalization (HR 1.08 95%CI 0.95–1.23).
Conclusions: In this study, WRF during HF hospitalization persisted to discharge in 61% of cases, and persistent WRF was associated with increased long term mortality and re-hospitalization while transient WRF was not. Efforts to identify predictors and prevention strategies for persistent WRF are needed.