Predictors and prognostic value of worsening renal function during admission in HFpEF Versus HFrEF: Data from the KorAHF (Korean acute heart failure) registry

Jeehoon Kang, Jin Joo Park, Young Jin Cho, Il Young Oh, Hyun Ah Park, Sang Eun Lee, Min Seok Kim, Hyun Jai Cho, Hae Young Lee, Jin Oh Choi, Kyung Kuk Hwang, Kye Hun Kim, Byung Su Yoo, Seok Min Kang, Sang Hong Baek, Eun Seok Jeon, Jae Joong Kim, Myeong Chan Cho, Shung Chull Chae, Byung Hee OhDong Ju Choi

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Abstract

Background--Worsening renal function (WRF) is associated with adverse outcomes in patients with heart failure. We investigated the predictors and prognostic value of WRF during admission, in patients with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF). Methods and Results--A total of 5625 patients were enrolled in the KorAHF (Korean Acute Heart Failure) registry. WRF was defined as an absolute increase in creatinine of ≥0.3 mg/dL. Transient WRF was defined as recovery of creatinine at discharge, whereas persistent WRF was indicated by a nonrecovered creatinine level. HFpEF and HFrEF were defined as a left ventricle ejection fraction ≥50% and ≤40%, respectively. Among the total population, WRF occurred in 3101 patients (55.1%). By heart failure subgroup, WRF occurred more frequently in HFrEF (57.0% versus 51.3%; P < 0.001 in HFrEF and HFpEF). Prevalence of WRF increased as creatinine clearance decreased in both heart failure subgroups. Among various predictors of WRF, chronic renal failure was the strongest predictor. WRF was an independent predictor of adverse in-hospital outcomes (HFrEF: odds ratio; 2.75; 95% confidence interval, 1.50- 5.02; P=0.001; HFpEF: odds ratio, 9.48; 95% confidence interval, 1.19-75.89; P=0.034) and 1-year mortality (HFrEF: hazard ratio, 1.41; 95% confidence interval, 1.12-1.78; P=0.004 versus HFpEF: hazard ratio, 1.72; 95% confidence interval, 1.23-2.42; P=0.002). Transient WRF was a risk factor for 1-year mortality, whereas persistent WRF had no additive risk compared to transient WRF. Conclusions--In patients with acute heart failure patients, WRF is an independent predictor of adverse in-hospital and follow-up outcomes in both HFrEF and HFpEF, though with a different effect size.

Original languageEnglish
Article numbere007910
JournalJournal of the American Heart Association
Volume7
Issue number6
DOIs
Publication statusPublished - 2018 Mar 20

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kang, J., Park, J. J., Cho, Y. J., Oh, I. Y., Park, H. A., Lee, S. E., Kim, M. S., Cho, H. J., Lee, H. Y., Choi, J. O., Hwang, K. K., Kim, K. H., Yoo, B. S., Kang, S. M., Baek, S. H., Jeon, E. S., Kim, J. J., Cho, M. C., Chae, S. C., ... Choi, D. J. (2018). Predictors and prognostic value of worsening renal function during admission in HFpEF Versus HFrEF: Data from the KorAHF (Korean acute heart failure) registry. Journal of the American Heart Association, 7(6), [e007910]. https://doi.org/10.1161/JAHA.117.007910