Worsening Renal Function at 1 Year After Acute Heart Failure: A Report From the WET-HF2 Registry

The prognostic impact of worsening renal function (WRF) during the vulnerable phase following discharge after hospitalization for acute decompensated heart failure (HF) remains unclear. This study investigated the determinants of WRF 1 year after discharge (1Y-WRF) and its association with clinical outcomes in patients with acute decompensated HF.

Data were analyzed for 1753 patients hospitalized with acute decompensated HF from WET-HF2 (West Tokyo Heart Failure 2), a multicenter registry. 1Y-WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR). The primary end point was a composite of all-cause mortality and HF rehospitalization beyond 1 year after discharge. Exploratory subgroup analyses were conducted based on age, sex, left ventricular ejection fraction, diabetes, eGFR, HF rehospitalization, and loop diuretic intensification within 1 year after discharge, anemia, and renin-angiotensin-aldosterone system inhibitors use.

Of the 1753 patients (median age 76 years, 39.9% female, median eGFR 50.7 mL/min per 1.73 m² at discharge), 285 (16.3%) developed 1Y-WRF. Female sex, anemia, higher New York Heart Association class, and higher eGFR at discharge were associated with 1Y-WRF. Over a median follow-up of 1 year, 1Y-WRF was associated with an increased risk of the composite end point (adjusted hazard ratio, 1.34 [95% CI, 1.02-1.75], P=0.035), primarily driven by HF rehospitalization. The adverse prognostic impact was notable in young patients and those with high eGFR and no HF rehospitalization within 1 year after discharge.

In a contemporary cohort of acute decompensated heart failure 1Y-WRF was relatively common and associated with subsequent worse clinical outcomes.