Renal function trajectories and clinical outcomes in acute heart failure

Area of Science:

• Cardiology
• Nephrology
• Clinical Research

Background:

• Acute heart failure (AHF) is frequently associated with impaired renal function.
• Previous studies highlight risks linked to baseline and worsening kidney function in AHF.
• No prior research has modeled renal function change trajectories in AHF.

Purpose of the Study:

• To model the trajectories of renal function change in patients with AHF and renal dysfunction.
• To assess the impact of these renal trajectories on 180-day mortality and 60-day readmission risks.

Main Methods:

• Linear mixed models analyzed serial blood urea nitrogen (BUN) and creatinine measurements in 1962 AHF patients.
• Cox regression determined associations between renal trajectories and clinical outcomes.
• Data sourced from the "Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function" study.

Main Results:

• Creatinine levels generally increased from day 1 to 3 and post-discharge, with trajectories varying by discharge timing.
• Elevated baseline BUN (>35 mg/dL) and a daily creatinine increase (>0.1 mg/dL) significantly raised mortality risk.
• Blood urea nitrogen, creatinine, and the rate of creatinine change were strong predictors of mortality and readmission; BUN change rate was not.

Conclusions:

• Renal indices in AHF patients with renal dysfunction exhibit variable patterns during and after hospitalization.
• Baseline renal function and creatinine trajectory within the first 7 days are key predictors of morbidity and mortality risk.