Admission Renal Dysfunction Severity as a Prognostic Factor in Older Patients With Acute Heart Failure

Renal dysfunction (RD) is common at admission for acute heart failure (AHF), but there is limited evidence focusing on older adults and considering the influence of physical function. We evaluated the prognostic significance of admission RD severity as a risk factor for adverse outcomes in older patients with AHF, while considering the potential modifying effect of physical function.

This multicenter prospective cohort study enrolled 710 patients aged ≥65 years with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². Admission RD was stratified into 4 severity classes: mild RD (eGFR 45-59), moderate RD (eGFR 30-44), severe RD (eGFR 15-29), and kidney failure (eGFR <15). The primary outcome was a composite of HF readmission and all-cause death within 1 year post-discharge. Subgroup analyses assessed potential effect modification by physical function and other variables. After multivariable adjustment, severe RD or kidney failure was significantly associated with a higher risk of the composite outcome compared with mild RD (adjusted hazard ratio: 1.529; 95% confidence interval: 1.005-2.326). A possible interaction was observed between moderate RD and the Short Physical Performance Battery score at discharge (P for interaction=0.093).

Severe RD or kidney failure at admission independently predicted 1-year HF readmission and all-cause death. In moderate RD, physical function may modify RD prognostic impact.