The pathophysiology and treatment of acute decompensated heart failure (HF) in the presence of chronic kidney disease (CKD) remain ill defined. Here we compared the prognostic factors for 1-year mortality in patients with acute HF with and without CKD. We retrospectively studied 392 consecutive patients with acute decompensated HF. CKD as a comorbidity in these patients was defined by an estimated glomerular filtration rate of <60 mL/min/1.73 m2. Potential risk factors for 1-year mortality were selected by univariate analyses; then multivariate Cox regression analysis with forward selection (likelihood ratio) was performed to identify significant factors. Across the study cohort, 65% of patients had CKD, and the 1-year mortality rate was 9.2%. In the HF with CKD group, older age, lower systolic blood pressure at admission, discharge medications without beta-blockers, and discharge medications without diuretics were independent risk factors for 1-year mortality. In contrast, coexisting chronic obstructive pulmonary disease and higher C-reactive protein levels were independent risk factors for 1-year mortality in the HF without CKD group. Kaplan-Meier survival curves showed that discharge medications with no beta-blockers or diuretics correlated with significantly lower survival rates in patients with CKD (P < 0.001 in both groups, log-rank test), but not in patients without CKD (P = 0.822 and P = 0.374, respectively, log-rank test). Thus, there were significant differences in the prognostic factors for 1-year mortality between acute HF patients with and without CKD including beta-blocker and diuretic treatments. These findings suggest that patients with HF might benefit from individualized therapies.
Keywords: cardiorenal syndrome; chronic kidney disease; heart failure; individualized treatment.