Cardiology

HF and Intensive Care: Research Article

Worsening Renal Function during Index Hospitalization Does Not Predict Prognosis in Heart Failure with Preserved Ejection Fraction Patients

Rasalingam R.d · Parker R.a · Kurgansky K.E.a · Djousse L.a,b · Gagnon D.a,c · Joseph J.a,d

Author affiliations

aMassachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, USA
bDivision of Aging, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
cDepartment of Biostatistics, Boston University School of Public Health, Boston, MA, USA
dDepartment of Medicine Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Keywords: Worsening renal functionHeart failure with preserved ejection fraction

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Cardiology 2021;146:179–186
https://doi.org/10.1159/000512431

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Article / Publication Details

First-Page Preview
Abstract of HF and Intensive Care: Research Article

Received: March 10, 2020
Accepted: October 10, 2020
Published online: February 01, 2021
Issue release date: March 2021

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 3

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: https://www.karger.com/CRD

Abstract

Introduction: Worsening renal function (WRF) predicts poor prognosis in patients with left ventricular systolic dysfunction. The effect of WRF in heart failure with preserved ejection fraction (HFpEF) is unclear. Objective: The objective of this study was to determine whether WRF during index hospitalization for HFpEF is associated with increased death or readmission for heart failure. Methods: National Veterans Affairs electronic medical data recorded between January 1, 2002, and December 31, 2014, were screened to identify index hospitalizations for HFpEF using an iterative algorithm. Patients were divided into 3 groups based on changes in serum Cr (sCr) during this admission. WRF was defined as a rise in sCr ≥0.3 mg/dL. Group 1 had no evidence of WRF, group 2 had transient WRF, and group 3 had persistent WRF at the time of discharge. Results: A total of 10,902 patients with index hospitalizations for HFpEF were identified (mean age 72, 97% male). Twenty-nine percent had WRF during this hospital admission, with 48% showing recovery of sCr and 52% with no recovery at discharge. The mortality rate over a mean follow-up duration of 3.26 years was 72%. Compared to group 1, groups 2 and 3 showed no significant difference in risk of death from any cause (hazard ratio [HR] = 0.95 [95% confidence interval [CI]: 0.87, 1.03] and 1.02 [95% CI: 0.93, 1.11], respectively), days hospitalized for any cause (incidence density ratio [IDR] = 1.01 [95% CI: 0.92, 1.11] and 1.01 [95% CI: 0.93, 1.11], respectively), or days hospitalized for heart failure (IDR = 0.94 [95% CI: 0.80, 1.10] and 0.94 [95% CI: 0.81, 1.09], respectively) in analyses adjusted for covariates affecting renal function and outcomes. Conclusions: While there is a high incidence of WRF during index hospitalizations for HFpEF, WRF is not associated with an increased risk of death or hospitalization. This suggests that WRF alone should not influence decisions regarding heart failure management.

© 2021 S. Karger AG, Basel



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References

  1. Unger ED, Dubin RF, Deo R, Daruwalla V, Friedman JL, Medina C, et al. Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction. Eur J Heart Fail. 2016;18(1):103–12.
    External Resources
  2. Damman K, Perez AC, Anand IS, Komajda M, McKelvie RS, Zile MR, et al. Worsening renal function and outcome in heart failure patients with preserved ejection fraction and the impact of angiotensin receptor blocker treatment. J Am Coll Cardiol. 2014;64(11):1106–13.
    External Resources
  3. Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP. Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation. 2010;122(3):265–72.
    External Resources
  4. Patel YR, Robbins JM, Kurgansky KE, Imran T, Orkaby AR, McLean RR, et al. Development and validation of a heart failure with preserved ejection fraction cohort using electronic medical records. BMC Cardiovasc Disord. 2018;18(1):128.
    External Resources
  5. Forman DE, Butler J, Wang Y, Abraham WT, O’Connor CM, Gottlieb SS, et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol. 2004;43(1):61–7.
    External Resources
  6. Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, et al. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail. 2007;13(8):599–608.
    External Resources
  7. Löfman I, Szummer K, Evans M, Carrero J-J, Lund LH, Jernberg T. Incidence of, associations with and prognostic impact of worsening renal function in heart failure with different ejection fraction categories. Am J Cardiol. 2019 Nov 15;124(10):1575–83.
  8. Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2000;35(3):681–9.
    External Resources
  9. Miller WL, Mullan BP. Understanding the heterogeneity in volume overload and fluid distribution in decompensated heart failure is key to optimal volume management: role for blood volume quantitation. JACC Heart Fail. 2014;2(3):298–305.
    External Resources
  10. Westermann D, Kasner M, Steendijk P, Spillmann F, Riad A, Weitmann K, et al. Role of left ventricular stiffness in heart failure with normal ejection fraction. Circulation. 2008;117(16):2051–60.
    External Resources
  11. Sharma K, Vaishnav J, Kalathiya R, Hu JR, Miller J, Shah N, et al. Randomized evaluation of heart failure with preserved ejection fraction patients with acute heart failure and dopamine: the ROPA-DOP trial. JACC Heart Fail. 2018;6(10):859–70.
    External Resources
  12. Takei M, Kohsaka S, Shiraishi Y, Goda A, Izumi Y, Yagawa M, et al. Effect of estimated plasma volume reduction on renal function for acute heart failure differs between patients with preserved and reduced ejection fraction. Circ Heart Fail. 2015;8(3):527–32.
    External Resources
  13. McAlister FA, Ezekowitz J, Tarantini L, Squire I, Komajda M, Bayes-Genis A, et al. Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new chronic kidney disease-epidemiology collaboration group formula. Circ Heart Fail. 2012;5(3):309–14.
    External Resources
  14. Breidthardt T, Weidmann ZM, Twerenbold R, Gantenbein C, Stallone F, Rentsch K, et al. Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function. Eur J Heart Fail. 2017;19(2):226–36.
    External Resources
  15. Rusinaru D, Buiciuc O, Houpe D, Tribouilloy C. Renal function and long-term survival after hospital discharge in heart failure with preserved ejection fraction. Int J Cardiol. 2011;147(2):278–82.
    External Resources
  16. Sharma K, Hill T, Grams M, Daya NR, Hays AG, Fine D, et al. Outcomes and worsening renal function in patients hospitalized with heart failure with preserved ejection fraction. Am J Cardiol. 2015;116(10):1534–40.
    External Resources
  17. Kang J, Park JJ, Cho YJ, Oh IY, Park HA, Lee SE, et al. Predictors and prognostic value of worsening renal function during admission in HFpEF versus HFrEF: data from the KorAHF (Korean acute heart failure) registry. J Am Heart Assoc. 2018;7(6):e007910.
    External Resources
  18. Sato YU, Yoshihisa A, Oikawa M, Nagai T, Yoshikawa T, Saito Y, et al. Prognostic impact of worsening renal function in hospitalized heart failure patients with preserved ejection fraction: a report from the JASPER registry. J Card Fail. 2019 Aug;25(8):631–42.
  19. Pfeffer MA, Claggett B, Assmann SF, Boineau R, Anand IS, Clausell N, et al. Regional variation in patients and outcomes in the treatment of preserved cardiac function heart failure with an aldosterone antagonist (TOPCAT) trial. Circulation. 2015;131(1):34–42.
    External Resources
  20. Kristensen SL, Køber L, Jhund PS, Solomon SD, Kjekshus J, McKelvie RS, et al. International geographic variation in event rates in trials of heart failure with preserved and reduced ejection fraction. Circulation. 2015;131(1):43–53.
    External Resources
  21. Shah KS, Xu H, Matsouaka RA, Bhatt DL, Heidenreich PA, Hernandez AF, et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol. 2017;70(20):2476–86.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of HF and Intensive Care: Research Article

Received: March 10, 2020
Accepted: October 10, 2020
Published online: February 01, 2021
Issue release date: March 2021

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 3

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: https://www.karger.com/CRD

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2021, Vol.146, No. 2

March 2021

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