Different Renal Function Patterns in Patients With Acute Heart Failure: Relationship With Outcome and Congestion

Alberto Palazzuoli; Federico Crescenzi; Lorenzo Luschi; Angelica Brazzi; Mauro Feola; Arianna Rossi; Antonio Pagliaro; Nicolò Ghionzoli; Gaetano Ruocco

doi:10.3389/fcvm.2022.779828

Different Renal Function Patterns in Patients With Acute Heart Failure: Relationship With Outcome and Congestion

Front Cardiovasc Med. 2022 Mar 7:9:779828. doi: 10.3389/fcvm.2022.779828. eCollection 2022.

Authors

Alberto Palazzuoli¹, Federico Crescenzi², Lorenzo Luschi¹, Angelica Brazzi¹, Mauro Feola³, Arianna Rossi⁴, Antonio Pagliaro⁵, Nicolò Ghionzoli¹, Gaetano Ruocco⁶

Affiliations

¹ Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, University of Siena, Siena, Italy.
² Department of Statistics, University of Florence, Florence, Italy.
³ Cardiology Section, Regina Montis Regalis Hospital, ASL-CN1, Cuneo, Italy.
⁴ Department of Geriatrics, University of Turin, Turin, Italy.
⁵ Cardiology Unit, Le Scotte Hospital, University of Siena, Siena, Italy.
⁶ Cardiology Unit, "Riuniti of Valdichiana" Hospital, Usl-Sudest Toscana, Montepulciano, Italy.

Abstract

Background: The role of worsening renal function during acute heart failure (AHF) hospitalization is still debated. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements.

Objectives: To investigate the prognostic relevance of different RF trajectories together with the congestion status in hospitalized patients.

Methods: This is a post hoc analysis of a multi-center study including 467 patients admitted with AHF who were screened for the Diur-AHF Trial. We recognized five main RF trajectories based on serum creatinine and estimated glomerular filtration rate (eGFR) behavior. According to the RF trajectories our sample was divided into 1-stable (S), 2-transient improvement (TI), 3-permanent improvement (PI), 4-transient worsening (TW), and 5-persistent worsening (PW). The primary outcome was the combined endpoint of 180 days including all causes of mortality and re-hospitalization.

Results: We recruited 467 subjects with a mean congestion score of 3.5±1.08 and a median creatinine value of 1.28 (1.00-1.70) mg/dl, eGFR 50 (37-65) ml/min/m² and NTpro B-type natriuretic peptide (BNP) 7,000 (4,200-11,700) pg/ml. A univariate analysis of the RF pattern demonstrated that TI and PW patterns were significantly related to poor prognosis [HR: 2.71 (1.81-4.05); p < 0.001; HR: 1.68 (1.15-2.45); p = 0.007, respectively]. Conversely, the TW pattern showed a significantly protective effect on outcome [HR:0.34 (0.19-0.60); p < 0.001]. Persistence of congestion and BNP reduction ≥ 30% were significantly related to clinical outcome at univariate analysis [HR: 2.41 (1.81-3.21); p < 0.001 and HR:0.47 (0.35-0.67); p < 0.001]. A multivariable analysis confirmed the independently prognostic role of TI, PW patterns, persistence of congestion, and reduced BNP decrease at discharge.

Conclusions: Various RF patterns during AHF hospitalization are associated with different risk(s). PW and TI appear to be the two trajectories related to worse outcome. Current findings confirm the importance of RF evaluation during and after hospitalization.

Keywords: acute heart failure (AHF); congestion; outcome; renal dysfunction; worsening renal function (WRF).