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Int J Cardiol. 2008 Jul 4;127(2):228-32. Epub 2007 Jul 24.

Transient worsening of renal function during hospitalization for acute heart failure alters outcome.

Author information

1
Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France. damien.logeart@lrb.ap-hop-paris.fr

Abstract

OBJECTIVE:

We studied prevalence, causes and consequences of worsening renal function (WRF) during hospitalization for acute heart failure (AHF).

METHODS:

Patients admitted for AHF were enrolled. Patients with severe chronic renal failure, cardiogenic shock and contrast medium-induced nephropathy were excluded. WRF was defined as an increase of 25 mumol/l or more in serum creatinine relative to the admission level. Survivors were monitored for 6 months, focusing on deaths and first unscheduled readmissions for heart failure.

RESULTS:

Among the included 416 patients, WRF occurred in 152 cases (37%), 5+/-3 days after admission, and two-thirds of patients recovered their baseline renal function before discharge. Old age, diabetes, hypertension and acute coronary syndromes increased the risk of WRF. In-hospital furosemide doses as well as discharge treatment were similar in WRF and no-WRF patients. Serum creatinine elevation was the strongest independent determinant of a longer hospital stay (r=0.37, p=0.001). Adverse events occurred in 158 patients (38%) during follow-up, with 23 deaths and 135 readmissions. Cox analysis showed that WRF, transient or not, was an independent predictor of the risk of death or readmission (hazard ratio=1.74 [1.14-2.68], p=0.01).

CONCLUSION:

WRF is frequent after admission for AHF and, although transient, is associated with longer hospitalization and with a higher risk of death and readmission, irrespectively of baseline renal function.

PMID:
17651843
DOI:
10.1016/j.ijcard.2007.06.007
[Indexed for MEDLINE]
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