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

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 m²) 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.