Abstract 13105: Acute Cardiorenal Syndrome: The Prevalence of Impaired, Improved and Stable Renal Function in Patients With Acute Heart Failure
Introduction: Acute heart failure (AHF) is frequently accompanied by worsening renal function (WRF) and this has been linked to poor outcomes. However, prior studies have not accounted for the changes in renal function relative to baseline renal function, or the outcomes of patients with improved renal function (RF). We investigated the prevalence of WRF and improved RF in patients admitted with AHF.
Methods: We included 276 AHF patients enrolled at the University of Alberta Hospital into the AHF-EM study. Definitions from the Kidney Disease Outcomes Quality Initiative (K/DOQI) stages (1-5 stages) were used using eGFR (MDRD) from baseline and discharge. WRF was defined as worsening from stage 1, 2, 3a at admission to 3B or worse, from 3B to worse, or from 4 to 5. Improved RF was defined as improvement of at least one class from 3B, 4 or 5. Stable RF was defined as renal function within the same K/DOQI stage in stages 3A, 3B, 4, or 5.
Results: Patients were a mean age of 76 years, 50% were male, 34% had diabetes and the mean ejection fraction was 41%. The prevalence of WRF was 13%, Improved RF 10% and stable RF 31%. Improved RF patients were found to have the lowest in-hospital mortality rates (0%), compared to Stable RF (7%) and WRF patients (16%) (p=0.016). Patterns of medication use, medical history or admission parameters such as blood pressure, hydration status, and blood serum electrolytes were not significantly different among groups.
Conclusion: When patients with an eGFR <60 ml/min/1.73m2 are considered, the prevalence of WRF is lower than previously estimated, and interestingly a similar number of patients show improvement of RF. Improvement of RF upon treatment of AHF likely indicates ‘genuine’ acute cardiorenal syndrome, while those with WRF may be ‘treatment associated’ acute cardiorenal syndrome. The latter may reflect more severe underlying pathophysiological picture that leads to poor outcomes. (the study was funded by the Canadian Institute for Health Research)
- © 2013 by American Heart Association, Inc.