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

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 m(2)) 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.