Worsened renal function (WRF) during heart failure (HF) hospitalization is associated
with in-hospital mortality, but there are limited data regarding its relation to long-term
outcomes after discharge. The influence of WRF resolution is also unknown. This retrospective
study analyzed patients who received care from a large health system and had a primary
hospital discharge diagnosis of HF from January 2000 to June 2008. Renal function
was estimated from creatinine levels during hospitalization. The first available value
was considered baseline. WRF was defined a creatinine increase ≥0.3 mg/dl on any subsequent
hospital day compared to baseline. Persistent WRF was defined as having WRF at discharge.
Proportional hazards regression, adjusting for baseline renal function and potential
confounding factors, was used to assess time to rehospitalization or death. Of 2,465
patients who survived to discharge, 887 (36%) developed WRF. Median follow-up was
2.1 years. In adjusted models, WRF was associated with higher rates of postdischarge
death or rehospitalization (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.02
to 1.22). Of those with WRF, 528 (60%) had persistent WRF, whereas 359 (40%) recovered.
Persistent WRF was significantly associated with higher postdischarge event rates
(HR 1.14, 95% CI 1.02 to 1.27), whereas transient WRF showed only a nonsignificant
trend toward risk (HR 1.09, 95% CI 0.96 to 1.24). In conclusion, in patients surviving
hospitalization for HF, WRF was associated with increased long-term mortality and
rehospitalization, particularly if renal function did not recover by the time of discharge.
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Article Info
Publication History
Accepted:
August 21,
2010
Received in revised form:
August 21,
2010
Received:
July 13,
2010
Footnotes
This research was funded by a research grant from Merck, Inc. , Whitehouse Station, New Jersey, and supported in part by Career Development Award K23HL085124 to Dr. Lanfear from the National Heart, Lung, and Blood Institute , Bethesda, Maryland.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
