Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH)

Cowie, Martin R.; Komajda, Michel; Murray‐Thomas, Tarita; Underwood, Jonathan; Ticho, Barry

doi:10.1093/eurheartj/ehi859

Cited by 304 publications

(287 citation statements)

References 21 publications

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“…Our study confirms previous reports of the high prevalence of WRF in patients hospitalised for acute HF and its important impact on hospital length of stay and prognosis [9][10][11][13][14][15][16][17]. Our study differs from most of the previous studies, however, in that this was a prospectively designed single center protocol.…”

Section: Patient Characteristicssupporting

confidence: 87%

“…The most widely used definition of WRF in previous studies has been an increase of ≥0.3 mg/dL in s-Cr [8,10,13,[15][16][17]23]. However, the inverse relationship between glomerular filtration rate (GFR) and s-Cr is exponential, so that small changes in s-Cr are attended by greater reductions in GFR at low initial s-Cr, compared to higher s-Cr levels [18].…”

Section: Definition Of Wrfmentioning

confidence: 99%

“…More than half of the patients hospitalised for HF have some degree of impairment of renal function, and moderate to severe impairment has been reported in 30-35% of cases [7,[9][10][11][12][13]. Hospitalisation for acute HF is associated with further worsening of renal function (WRF) in 30-50% of patients, depending on the specific definition utilized, and this is associated with prolonged length of hospital stay, increased healthcare costs, increased in-hospital mortality, and higher rates of rehospitalisation and death post-discharge [9][10][11][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…With two exceptions [16,17], data on treatment, an important determinant of renal function changes, were not available or utilized. The studies also had relatively short follow-up duration, limited to the inhospital course in many studies [13,15,16] and up to 6 months in others [9,10,17]. Lastly, there is no consensus on how best to define WRF, with some studies utilizing the absolute [9][10][11][12][13][15][16][17] and others using relative [14,18] changes in serum creatinine (s-Cr) values.…”

Section: Introductionmentioning

confidence: 99%

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Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Metra

Nodari

Parrinello

et al. 2008

European J of Heart Fail

346

251

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Background: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF). Methods and results: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a ≥25% and a ≥ 0.3 mg/dL increase in serum creatinine (s-Cr) from admission (WRF-Abs-%). Results: Patients were followed for 480 ± 363 days. Fifty-three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF-Abs-% occurred in 107 (34%) patients. At multivariable survival analysis, WRF-Abs-% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13-1.81; p = 0.024). The independent predictors of WRF-Abs-%, evaluated using multivariable logistic regression, were history of chronic kidney disease (p = 0.002), LV ejection fraction (p = 0.012), furosemide daily dose (p = 0.03) and NYHA class (p = 0.05) on admission. Conclusion: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.

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Section: Patient Characteristicssupporting

confidence: 87%

Section: Definition Of Wrfmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Metra

Nodari

Parrinello

et al. 2008

European J of Heart Fail

346

251

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Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review

Lee

Huang

Yang

et al. 2022

Clinical Cardiology

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Background The heart and kidneys had demonstrated a bidirectional interaction that dysfunction of the heart or kidneys can induce dysfunction in the other organ. Hypothesis Renal function and its decline during hospitalization may have impact on cardiovascular outcomes in patients with acute decompensated heart failure (ADHF). Methods A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four‐variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF) was defined as eGFR decline between admission (eGFR admission ) and predischarge (eGFR predischarge ). Clinical outcomes were defined as 4P‐major adverse cardiovascular events (4P‐MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. Results During an average 2.6 ± 3.2 years follow‐up, 66 patients (55%) experienced 4P‐MACE. Patients with impaired eGFR predischarge (<60 ml/min/1.73 m 2 ) had more 4P‐MACE than those with preserved eGFR predischarge (64.7% vs. 43.1%, p = .019). The Kaplan–Meier survival curves showed significantly higher incidence of 4P‐MACE in patients with impaired eGFR predischarge than those with preserved eGFR predischarge ( p = .002). Cox regression analysis revealed that impaired eGFR predischarge was significantly correlated with the development of 4P‐MACE (hazard ratio, 2.003; 95% confidence interval, 1.072–3.744; p = .029). In contrast, outcomes would be similar with regard to eGFR on admission and eGFR decline during hospitalization. Conclusions Impaired renal function before discharge, but not impaired renal function on admission or WRF, is a significant risk factor for poor outcomes in patients with ADHF.

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Single baseline serum creatinine measurements predict mortality in critically ill patients hospitalized for acute heart failure

et al. 2015

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BackgroundAcute heart failure (AHF) is a leading cause of death in critically ill patients and is often accompanied by significant renal dysfunction. Few data exist on the predictive value of measures of renal dysfunction in large cohorts of patients hospitalized for AHF.MethodsSix hundred and eighteen patients hospitalized for AHF (300 male, aged 73.3 ± 10.3 years, 73% New York Heart Association Class 4, mean hospital length of stay 12.9 ± 7.7 days, 97% non‐ischaemic AHF) were included in a retrospective single‐centre data analysis. Echocardiographic data, serum creatinine/urea levels, estimated glomerular filtration rate (eGFR), and clinical/laboratory markers were recorded. Mean follow‐up time was 2.9 ± 2.1 years. All‐cause mortality was recorded, and univariate/multivariate analyses were performed.ResultsNormal renal function defined as eGFR > 90 mL/min/1.73 m2 was noted in only 3% of AHF patients at baseline. A significant correlation of left ventricular ejection fraction with serum creatinine levels and eGFR (all P < 0.002) was noted. All‐cause mortality rates were 12% (90 days) and 40% (at 2 years), respectively. In a multivariate model, increased age, higher New York Heart Association class at admission, higher total cholesterol levels, and lower eGFR independently predicted death. Patients with baseline eGFR < 30 mL/min/1.73 m2 had an exceptionally high risk of death (odds ratio 2.80, 95% confidence interval 1.52–5.15, P = 0.001).ConclusionsIn a large cohort of patients with mostly non‐ischaemic AHF, enhanced serum creatinine levels and reduced eGFR independently predict death. It appears that patients with eGFR < 30 mL/min/1.73 m2 have poorest survival rates. Our data add to mounting data indicating that impaired renal function is an important risk factor for non‐survival in patients hospitalized for AHF.

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Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH)

Abstract: WRF is common in patients admitted to European hospitals with decompensated HF. Such patients have longer duration admissions, but a similar mortality and re-hospitalization rate to those without WRF (if patients experiencing a major in-hospital complication are excluded).

Cited by 304 publications

References 21 publications

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review

Single baseline serum creatinine measurements predict mortality in critically ill patients hospitalized for acute heart failure

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