Impact of renal dysfunction on prognosis in patients with severe heart failure: A retrospective cohort study

This study aims to investigate the prevalence of renal insufficiency and its prognostic impact on patients with severe heart failure (HF), particularly those classified as New York Heart Association class IV, and to identify independent clinical predictors associated with renal dysfunction in this population. This retrospective cohort study analyzed clinical data from 120 patients hospitalized with New York Heart Association class IV HF between June 1, 2020, and June 30, 2023. Based on eGFR at admission, patients were categorized into 3 groups: normal renal function (eGFR ≥ 90 mL/min/1.73 m²), mild renal insufficiency (60 ≤ eGFR < 90 mL/min/1.73 m²), and moderate-to-severe renal insufficiency (eGFR < 60 mL/min/1.73 m²). Demographic, biochemical, and survival data were collected and analyzed using multivariate regression and Kaplan-Meier survival analysis. Renal insufficiency was identified in 66.67% of the patients, with 33.33% having normal renal function, 35.00% having mild renal insufficiency, and 31.67% having moderate-to-severe renal insufficiency. Multivariate analysis revealed that age (OR = 1.422, P = .041), serum creatinine (OR = 2.951, P = .016), blood urea nitrogen (OR = 2.287, P = .026), and triiodothyronine levels (OR = 0.646, P = .040) were independently associated with renal dysfunction in this cohort. Patients with moderate-to-severe renal insufficiency experienced significantly higher rates of all-cause mortality (47.37% vs 22.50% in the normal renal function group and 35.71% in the mild renal insufficiency group, P = .033) and rehospitalization (60.53% vs 40.00% in the normal renal function group and 45.24% in the mild renal insufficiency group, P = .027). Kaplan-Meier analysis showed that the median survival was shortest in the moderate-to-severe renal insufficiency group (5.50 months), in contrast to 10.80 months in the mild renal insufficiency group and 11.25 months in the normal renal function group (P < .001). Moderate-to-severe renal insufficiency is highly prevalent among patients with advanced HF and is associated with significantly worse clinical outcomes. These findings underscore the importance of early detection and tailored management strategies to improve survival and reduce rehospitalization in this high-risk population.