Implications of worsening renal function before hospitalization for acute heart failure
Abstract Aims Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). Methods and results We evalua...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-02-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14221 |
| _version_ | 1797944759289905152 |
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| author | Nicholas Wettersten Stephen Duff Yu Horiuchi Dirk J. vanVeldhuisen Christian Mueller Gerasimos Filippatos Richard Nowak Christopher Hogan Michael C. Kontos Chad M. Cannon Gerhard A. Müeller Robert Birkhahn Pam Taub Gary M. Vilke Kenneth McDonald Niall Mahon Julio Nuñez Carlo Briguori Claudio Passino Alan Maisel Patrick T. Murray Joachim H. Ix |
| author_facet | Nicholas Wettersten Stephen Duff Yu Horiuchi Dirk J. vanVeldhuisen Christian Mueller Gerasimos Filippatos Richard Nowak Christopher Hogan Michael C. Kontos Chad M. Cannon Gerhard A. Müeller Robert Birkhahn Pam Taub Gary M. Vilke Kenneth McDonald Niall Mahon Julio Nuñez Carlo Briguori Claudio Passino Alan Maisel Patrick T. Murray Joachim H. Ix |
| author_sort | Nicholas Wettersten |
| collection | DOAJ |
| description | Abstract Aims Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). Methods and results We evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase–associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3 months before and at the time of admission. Admission WRF was primarily defined as a 0.3 mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5 mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in‐hospital events, and the composite of death or HF readmission at 30, 90, and 365 days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One‐hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16–1.28, 95% confidence interval [CI] 1.00–1.55) and lower diastolic blood pressure (OR 0.97–0.98, 95% CI 0.96–0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6 days longer, 95% CI 1.0–2.2). WRF across definitions was not associated with a higher odds of adverse in‐hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome. Conclusions Admission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in‐hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events. |
| first_indexed | 2024-04-10T20:44:45Z |
| format | Article |
| id | doaj.art-6c72ad215c2f4f30b3b2d505a58cf844 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-10T20:44:45Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-6c72ad215c2f4f30b3b2d505a58cf8442023-01-24T09:02:17ZengWileyESC Heart Failure2055-58222023-02-0110153254110.1002/ehf2.14221Implications of worsening renal function before hospitalization for acute heart failureNicholas Wettersten0Stephen Duff1Yu Horiuchi2Dirk J. vanVeldhuisen3Christian Mueller4Gerasimos Filippatos5Richard Nowak6Christopher Hogan7Michael C. Kontos8Chad M. Cannon9Gerhard A. Müeller10Robert Birkhahn11Pam Taub12Gary M. Vilke13Kenneth McDonald14Niall Mahon15Julio Nuñez16Carlo Briguori17Claudio Passino18Alan Maisel19Patrick T. Murray20Joachim H. Ix21Division of Cardiovascular Medicine San Diego Veterans Affairs Medical Center San Diego California USASchool of Medicine University College Dublin Dublin IrelandDivision of Cardiology Mitsui Memorial Hospital Tokyo JapanDepartment of Cardiology, University Medical Center Groningen University of Groningen Groningen The NetherlandsDepartment of Cardiology, University Hospital Basel University of Basel Basel SwitzerlandDepartment of Cardiology, Athens University Hospital Attikon University of Athens Athens GreeceDepartment of Emergency Medicine Henry Ford Hospital System Detroit Michigan USADivision of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center Virginia Commonwealth University Richmond Virginia USADivision of Cardiology, VCU Medical Center Virginia Commonwealth University Richmond Virginia USADepartment of Emergency Medicine University of Kansas Medical Center Kansas City Kansas USADepartment of Nephrology and Rheumatology, University Medical Center Göttingen University of Göttingen Göttingen GermanyDepartment of Emergency Medicine New York Methodist Brooklyn New York USADivision of Cardiovascular Medicine University of California, San Diego La Jolla California USADepartment of Emergency Medicine University of California, San Diego La Jolla California USADepartment of Cardiology, Mater Misericordiae University Hospital University College Dublin Dublin IrelandDepartment of Cardiology St. Vincent's University Hospital Dublin IrelandDepartment of Cardiology, Hospital Clínico Universitario Valencia, INCLIVA University of Valencia Valencia SpainDepartment of Cardiology, Interventional Cardiology Mediterranea Cardiocentro Naples ItalyDepartment of Cardiology and Cardiovascular Medicine Fondazione Gabriele Monasterio Pisa ItalyDivision of Cardiovascular Medicine University of California, San Diego La Jolla California USASchool of Medicine University College Dublin Dublin IrelandDivision of Nephrology‐Hypertension, Department of Medicine University of California San Diego La Jolla California USAAbstract Aims Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). Methods and results We evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase–associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3 months before and at the time of admission. Admission WRF was primarily defined as a 0.3 mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5 mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in‐hospital events, and the composite of death or HF readmission at 30, 90, and 365 days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One‐hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16–1.28, 95% confidence interval [CI] 1.00–1.55) and lower diastolic blood pressure (OR 0.97–0.98, 95% CI 0.96–0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6 days longer, 95% CI 1.0–2.2). WRF across definitions was not associated with a higher odds of adverse in‐hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome. Conclusions Admission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in‐hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events.https://doi.org/10.1002/ehf2.14221Acute heart failureAcute kidney injuryBiomarkersCardiorenal syndrome |
| spellingShingle | Nicholas Wettersten Stephen Duff Yu Horiuchi Dirk J. vanVeldhuisen Christian Mueller Gerasimos Filippatos Richard Nowak Christopher Hogan Michael C. Kontos Chad M. Cannon Gerhard A. Müeller Robert Birkhahn Pam Taub Gary M. Vilke Kenneth McDonald Niall Mahon Julio Nuñez Carlo Briguori Claudio Passino Alan Maisel Patrick T. Murray Joachim H. Ix Implications of worsening renal function before hospitalization for acute heart failure ESC Heart Failure Acute heart failure Acute kidney injury Biomarkers Cardiorenal syndrome |
| title | Implications of worsening renal function before hospitalization for acute heart failure |
| title_full | Implications of worsening renal function before hospitalization for acute heart failure |
| title_fullStr | Implications of worsening renal function before hospitalization for acute heart failure |
| title_full_unstemmed | Implications of worsening renal function before hospitalization for acute heart failure |
| title_short | Implications of worsening renal function before hospitalization for acute heart failure |
| title_sort | implications of worsening renal function before hospitalization for acute heart failure |
| topic | Acute heart failure Acute kidney injury Biomarkers Cardiorenal syndrome |
| url | https://doi.org/10.1002/ehf2.14221 |
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