Renal function and long-term survival after hospital discharge in heart failure with preserved ejection fraction

Abstract

Background: Baseline renal function and worsening of renal function (WRF) during hospitalization for heart failure (HF) have a major prognostic impact in patients with left ventricular systolic dysfunction.

Methods: We sought to prospectively investigate the impact of reduced baseline renal function and WRF during hospitalization on the 7-year outcome in 358 patients surviving a first admission to hospital for heart failure with preserved (≥ 50%) ejection fraction (HFPEF).

Results: Mean baseline estimated glomerular filtration rate (eGFR) was 59.4 ± 23.6 ml/min/1.73 m². Low admission eGFR (<60 ml/min/1.73 m²) was frequently observed (190 patients--53% of the study population). Low baseline eGFR was associated with an increased risk of 7-year overall mortality (unadjusted hazard ratio [HR] 1.43[1.10-1.86]; p = 0.007) and cardiovascular mortality (unadjusted HR 1.57[1.13-2.19]; p = 0.007). After adjustment for covariates, the relationships remained significant. During hospitalization, WRF occurred in 43 patients (12%). History of renal failure, baseline systolic blood pressure >160 mm Hg, and baseline atrial fibrillation were independent predictors of the development of WRF during hospitalization. WRF was independently predictive of 7-year overall mortality (adjusted HR 2.10[1.24-3.58]; p = 0.006) and cardiovascular mortality (adjusted HR 2.54[1.35-4.78]; p = 0.004) in patients with low baseline eGFR but not in those with baseline eGFR ≥ 60 ml/min/1.73 m².

Conclusions: In patients admitted for the first time for HFPEF, low baseline eGFR is a potent predictor of long-term mortality. Patients with impaired renal function at baseline who develop WRF during hospitalization have particularly poor prognosis.