BACKGROUND: In the setting of acute decompensated heart failure, worsening renal function (WRF) and improved renal function (IRF) have been associated with similar hemodynamic derangements and poor prognosis. Our aim was to further characterize IRF and its associated mortality risk. METHODS AND RESULTS: Consecutive patients with a discharge diagnosis of congestive heart failure at the Hospital of the University of Pennsylvania were reviewed. IRF was defined as a ≥20% improvement and WRF as a ≥20% deterioration in glomerular filtration rate. Overall, 903 patients met the eligibility criteria, with 31.4% experiencing IRF. Baseline venous congestion/right-side cardiac dysfunction was more common (P ≤ .04) and volume of diuresis (P = .003) was greater in patients with IRF. IRF was associated with a greater incidence of preadmission (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.6-6.7; P < .0001) and postdischarge (OR 1.8, 95% CI 1.2-2.7; P = .006) WRF. IRF was associated with increased mortality (adjusted hazard ratio 1.3, 95% CI, 1.1-1.7; P = .011), a finding largely restricted to patients with postdischarge recurrence of renal dysfunction (P interaction = .038). CONCLUSIONS: IRF is associated with significantly worsened survival and may represent the resolution of venous congestion-induced preadmission WRF. Unlike WRF, the renal dysfunction in IRF patients occurs independently from the confounding effects of acute decongestion and may provide incremental information for the study of cardiorenal interactions.
BACKGROUND: In the setting of acute decompensated heart failure, worsening renal function (WRF) and improved renal function (IRF) have been associated with similar hemodynamic derangements and poor prognosis. Our aim was to further characterize IRF and its associated mortality risk. METHODS AND RESULTS: Consecutive patients with a discharge diagnosis of congestive heart failure at the Hospital of the University of Pennsylvania were reviewed. IRF was defined as a ≥20% improvement and WRF as a ≥20% deterioration in glomerular filtration rate. Overall, 903 patients met the eligibility criteria, with 31.4% experiencing IRF. Baseline venous congestion/right-side cardiac dysfunction was more common (P ≤ .04) and volume of diuresis (P = .003) was greater in patients with IRF. IRF was associated with a greater incidence of preadmission (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.6-6.7; P < .0001) and postdischarge (OR 1.8, 95% CI 1.2-2.7; P = .006) WRF. IRF was associated with increased mortality (adjusted hazard ratio 1.3, 95% CI, 1.1-1.7; P = .011), a finding largely restricted to patients with postdischarge recurrence of renal dysfunction (P interaction = .038). CONCLUSIONS: IRF is associated with significantly worsened survival and may represent the resolution of venous congestion-induced preadmission WRF. Unlike WRF, the renal dysfunction in IRF patients occurs independently from the confounding effects of acute decongestion and may provide incremental information for the study of cardiorenal interactions.
Authors: Daniel E Forman; Javed Butler; Yongfei Wang; William T Abraham; Christopher M O'Connor; Stephen S Gottlieb; Evan Loh; Barry M Massie; Michael W Rich; Lynne Warner Stevenson; James B Young; Harlan M Krumholz Journal: J Am Coll Cardiol Date: 2004-01-07 Impact factor: 24.094
Authors: Mohammed W Akhter; Doron Aronson; Fahed Bitar; Salman Khan; Harpreet Singh; Rajinder P Singh; Andrew J Burger; Uri Elkayam Journal: Am J Cardiol Date: 2004-10-01 Impact factor: 2.778
Authors: Jeffrey M Testani; Amit V Khera; Martin G St John Sutton; Martin G Keane; Susan E Wiegers; Richard P Shannon; James N Kirkpatrick Journal: Am J Cardiol Date: 2010-01-05 Impact factor: 2.778
Authors: Michael Domanski; James Norman; Bertram Pitt; Mark Haigney; Stephen Hanlon; Eliot Peyster Journal: J Am Coll Cardiol Date: 2003-08-20 Impact factor: 24.094
Authors: Liviu Klein; Barry M Massie; Jeffrey D Leimberger; Christopher M O'Connor; Ileana L Piña; Kirkwood F Adams; Robert M Califf; Mihai Gheorghiade Journal: Circ Heart Fail Date: 2008-05 Impact factor: 8.790
Authors: Meredith A Brisco; Steven G Coca; Jennifer Chen; Anjali Tiku Owens; Brian D McCauley; Stephen E Kimmel; Jeffrey M Testani Journal: Circ Heart Fail Date: 2013-01-16 Impact factor: 8.790
Authors: Jeffrey M Testani; Meredith A Brisco; Gang Han; Olga Laur; Alexander J Kula; Susan J Cheng; Wai Hong Wilson Tang; Chirag R Parikh Journal: Am J Cardiol Date: 2013-10-03 Impact factor: 2.778