Worsening of renal function during 1 year after hospital discharge is a strong and independent predictor of all-cause mortality in acute decompensated heart failure

Tomoya Ueda, Rika Kawakami, Yu Sugawara, Sadanori Okada, Taku Nishida, Kenji Onoue, Tsunenari Soeda, Satoshi Okayama, Yukiji Takeda, Makoto Watanabe, Hiroyuki Kawata, Shiro Uemura, Yoshihiko Saito, Tomoya Ueda, Rika Kawakami, Yu Sugawara, Sadanori Okada, Taku Nishida, Kenji Onoue, Tsunenari Soeda, Satoshi Okayama, Yukiji Takeda, Makoto Watanabe, Hiroyuki Kawata, Shiro Uemura, Yoshihiko Saito

Abstract

Background: Renal impairment is a common comorbidity and the strongest risk factor for poor prognosis in acute decompensated heart failure (ADHF). In clinical practice, renal function is labile during episodes of ADHF, and often worsens after discharge. The significance of worsening of renal function (WRF) after discharge has not been investigated as extensively as baseline renal function at admission or WRF during hospitalization.

Methods and results: Among 611 consecutive patients with ADHF emergently admitted to our hospital, 233 patients with 3 measurements of serum creatinine (SCr) level measurements (on admission, at discharge, and 1 year after discharge) were included in the present study. Patients were divided into 2 groups according to the presence or absence of WRF at 1 year after discharge (1y-WRF), defined as an absolute increase in SCr >0.3 mg/dL (>26.5 μmol/L) plus a ≥25% increase in SCr at 1 year after discharge compared to the SCr value at discharge. All-cause and cardiovascular mortality were assessed as adverse outcomes. During a mean follow-up of 35.4 months, 1y-WRF occurred in 48 of 233 patients. There were 66 deaths from all causes. All-cause and cardiovascular mortality were significantly higher in patients with 1y-WRF (log-rank P<0.0001 and P<0.0001, respectively) according to Kaplan-Meier analysis. In a multivariate Cox proportional hazards model, 1y-WRF was a strong and independent predictor of all-cause and cardiovascular mortality. Hemoglobin and B-type natriuretic peptide at discharge, as well as left ventricular ejection fraction <50%, were independent predictors of 1y-WRF.

Conclusions: In patients with ADHF, 1y-WRF is a strong predictor of all-cause and cardiovascular mortality.

Keywords: acute decompensated heart failure; prognosis; worsening of renal function after discharge.

© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1.
Figure 1.
Kaplan–Meier event‐free survival curves for (A) all‐cause death and (B) cardiovascular death in patients with non‐WRF (dotted line; n=185) compared with patients with 1y‐WRF (solid line; n=48). WRF indicates worsening of renal function.
Figure 2.
Figure 2.
Kaplan–Meier event‐free survival curves for (A) all‐cause death and (B) cardiovascular death in patients with non‐WRF (dotted line; n=197) compared with patients with in‐hospital‐WRF (solid line; n=36). WRF indicates worsening of renal function.

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