Abstract 12436: Worsening of Renal Function after One Year, Not During Hospitalization, is Stronger Predictor of Prognosis in Patients With ADHF
Background: Renal dysfunction is one of the strongest risk factors for prognosis of acute decompensated heart failure (ADHF). In the real world, however, renal function is labile during the management of ADHF. Although the analyses using the baseline serum creatinine level (SCr) or worsening of SCr during hospitalization have been reported, significance of worsening of renal function (WRF) after discharge is not investigated well.
Method: In this context, 459 consecutive patients with ADHF emergently admitted to our hospital, we measured SCr at three points (on admission, at discharge and a year after discharge) in 192 patients. The patients were divided into 2 groups according to WRF, defined as an increase in SCr >0.3 mg/dl after one year from discharge. Kaplan-Meier survival analysis and Cox regression analysis with a proportional hazard model were performed to assess outcomes.
Result: During a mean follow-up of 37.1 months, there were 61 deaths from all causes, including 37 deaths from cardiovascular causes. Kaplan-Meier analysis showed that all-cause and cardiovascular death were significantly higher in patients with WRF than without WRF (52% vs 25%; P≤0.0001, 36% vs 13%; P≤0.0001, respectively). (Figure) In a multivariate analysis with clinical and laboratory variables, including BNP, Hb and eGFR at discharge, WRF was the independent predictor for all-cause and cardiovascular death (HR, 1.98; 95% CI, 1.05-3.71; P=0.0352, HR, 2.98; 95% CI, 1.36-6.56; P=0.0069, respectively). Hb was lower (11.1±1.7 vs 12.0±2.2 g/dl; P=0.0094) and BNP was higher (395 (154-571) vs 189 (105-395) pg/ml; P=0.0064) in patients with WRF than without WRF. However, there is no difference in frequency of use for loop diuretics in both groups (81% vs 88%).
Conclusion: Worsening of renal function after one year, not during hospitalization, is stronger predictor of all-cause mortality and cardiovascular death in patients with ADHF.
- © 2013 by American Heart Association, Inc.