Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Mar 2018)

Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry

  • Jeehoon Kang,
  • Jin Joo Park,
  • Young‐Jin Cho,
  • Il‐Young Oh,
  • Hyun‐Ah Park,
  • Sang Eun Lee,
  • Min‐Seok Kim,
  • Hyun‐Jai Cho,
  • Hae‐Young Lee,
  • Jin Oh Choi,
  • Kyung‐Kuk Hwang,
  • Kye Hun Kim,
  • Byung‐Su Yoo,
  • Seok‐Min Kang,
  • Sang Hong Baek,
  • Eun‐Seok Jeon,
  • Jae‐Joong Kim,
  • Myeong‐Chan Cho,
  • Shung Chull Chae,
  • Byung‐Hee Oh,
  • Dong‐Ju Choi

DOI
https://doi.org/10.1161/JAHA.117.007910
Journal volume & issue
Vol. 7, no. 6

Abstract

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BackgroundWorsening renal function (WRF) is associated with adverse outcomes in patients with heart failure. We investigated the predictors and prognostic value of WRF during admission, in patients with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF). Methods and ResultsA total of 5625 patients were enrolled in the KorAHF (Korean Acute Heart Failure) registry. WRF was defined as an absolute increase in creatinine of ≥0.3 mg/dL. Transient WRF was defined as recovery of creatinine at discharge, whereas persistent WRF was indicated by a nonrecovered creatinine level. HFpEF and HFrEF were defined as a left ventricle ejection fraction ≥50% and ≤40%, respectively. Among the total population, WRF occurred in 3101 patients (55.1%). By heart failure subgroup, WRF occurred more frequently in HFrEF (57.0% versus 51.3%; P<0.001 in HFrEF and HFpEF). Prevalence of WRF increased as creatinine clearance decreased in both heart failure subgroups. Among various predictors of WRF, chronic renal failure was the strongest predictor. WRF was an independent predictor of adverse in‐hospital outcomes (HFrEF: odds ratio; 2.75; 95% confidence interval, 1.50–5.02; P=0.001; HFpEF: odds ratio, 9.48; 95% confidence interval, 1.19–75.89; P=0.034) and 1‐year mortality (HFrEF: hazard ratio, 1.41; 95% confidence interval, 1.12–1.78; P=0.004 versus HFpEF: hazard ratio, 1.72; 95% confidence interval, 1.23–2.42; P=0.002). Transient WRF was a risk factor for 1‐year mortality, whereas persistent WRF had no additive risk compared to transient WRF. ConclusionsIn patients with acute heart failure patients, WRF is an independent predictor of adverse in‐hospital and follow‐up outcomes in both HFrEF and HFpEF, though with a different effect size. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01389843.

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