Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review

Hao-Wei Lee; Chin-Chou Huang; Chih-Yu Yang; Hsin-Bang Leu; Po-Hsun Huang; Tao-Cheng Wu; Shing-Jong Lin; Jaw-Wen Chen

doi:10.1002/clc.23934

Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review

Clin Cardiol. 2023 Jan;46(1):57-66. doi: 10.1002/clc.23934. Epub 2022 Nov 7.

Authors

Hao-Wei Lee¹, Chin-Chou Huang^{1

2

3

4}, Chih-Yu Yang^{2

5

6}, Hsin-Bang Leu^{1

2

4

7}, Po-Hsun Huang^{1

4

6

8}, Tao-Cheng Wu^{1

2

4}, Shing-Jong Lin^{1

4

6

9}, Jaw-Wen Chen^{1

3

4

7}

Affiliations

¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁷ Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan.
⁸ Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁹ Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.

Abstract

Background: The heart and kidneys had demonstrated a bidirectional interaction that dysfunction of the heart or kidneys can induce dysfunction in the other organ.

Hypothesis: Renal function and its decline during hospitalization may have impact on cardiovascular outcomes in patients with acute decompensated heart failure (ADHF).

Methods: A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF) was defined as eGFR decline between admission (eGFR_admission ) and predischarge (eGFR_predischarge ). Clinical outcomes were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization.

Results: During an average 2.6 ± 3.2 years follow-up, 66 patients (55%) experienced 4P-MACE. Patients with impaired eGFR_predischarge (<60 ml/min/1.73 m² ) had more 4P-MACE than those with preserved eGFR_predischarge (64.7% vs. 43.1%, p = .019). The Kaplan-Meier survival curves showed significantly higher incidence of 4P-MACE in patients with impaired eGFR_predischarge than those with preserved eGFR_predischarge (p = .002). Cox regression analysis revealed that impaired eGFR_predischarge was significantly correlated with the development of 4P-MACE (hazard ratio, 2.003; 95% confidence interval, 1.072-3.744; p = .029). In contrast, outcomes would be similar with regard to eGFR on admission and eGFR decline during hospitalization.

Conclusions: Impaired renal function before discharge, but not impaired renal function on admission or WRF, is a significant risk factor for poor outcomes in patients with ADHF.

Keywords: acute decompensated heart failure; cardiovascular event; hospitalization; renal function; worsening renal function.

Publication types

Review

MeSH terms

East Asian People*
Glomerular Filtration Rate
Heart Failure* / diagnosis
Heart Failure* / epidemiology
Heart Failure* / therapy
Hospitalization
Humans
Kidney / physiology
Prognosis
Retrospective Studies