Transient and persistent worsening renal function during hospitalization for acute heart failure

• Published in: The American heart journal Vol. 168; no. 6; pp. 891 - 900
• Main Authors: Krishnamoorthy, Arun, MD, Greiner, Melissa A., MS, Sharma, Puza P., MBBS, MPH, PhD, DeVore, Adam D., MD, Johnson, Katherine Waltman, PharmD, Fonarow, Gregg C., MD, Curtis, Lesley H., PhD, Hernandez, Adrian F., MD, MHS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014; Elsevier Limited
• Subjects: Acute Disease; Aged; Cardiovascular; Creatinine - blood; Disease Progression; Female; Heart attacks; Heart Failure - blood; Heart Failure - complications; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart Failure - therapy; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Kidney Function Tests - methods; Kidney Function Tests - statistics & numerical data; Male; Medicare; Mortality; Outcome Assessment (Health Care); Prognosis; Proportional Hazards Models; Renal Insufficiency - blood; Renal Insufficiency - diagnosis; Renal Insufficiency - epidemiology; Renal Insufficiency - etiology; Renal Insufficiency - physiopathology; Renal Insufficiency - prevention & control; Risk Assessment; Survival Analysis; United States - epidemiology; United States
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2014.08.016

Background Transient and persistent worsening renal function (WRF) may be associated with different risks during hospitalization for acute heart failure. We compared outcomes of patients hospitalized for acute heart failure with transient, persistent, or no WRF. Methods We identified patients 65 years or older hospitalized with acute heart failure from a clinical registry linked to Medicare claims data. We defined WRF as an increase in serum creatinine of ≥0.3 mg/dL after admission. We further classified patients with WRF by the difference between admission and last recorded serum creatinine levels into transient WRF (<0.3 mg/dL) or persistent WRF (≥0.3 mg/dL). We examined unadjusted rates and adjusted associations between 90-day outcomes and WRF status. Results Among 27,309 patients, 18,568 (68.0%) had no WRF, 3,205 (11.7%) had transient WRF, and 5,536 (20.3%) had persistent WRF. Patients with WRF had higher observed rates of 90-day postdischarge all-cause readmission and 90-day postadmission mortality ( P < .001). After multivariable adjustment, transient WRF (hazard ratio [HR] 1.19, 99% CI 1.05-1.35) and persistent WRF (HR 1.73, 99% CI 1.57-1.91) were associated with higher risks of 90-day postadmission mortality ( P < .001 for both). Compared with transient WRF, persistent WRF was associated with a higher risk of 90-day postadmission mortality (HR 1.46, 99% CI 1.28-1.66, P < .001). Conclusions Transient and persistent WRF during hospitalization for acute heart failure were associated with higher adjusted risks for 90-day all-cause postadmission mortality. Patients with persistent WRF had worse outcomes.