Recovery of worsening renal function after acute heart failure

Worsening renal function (WRF) is common during hospitalization for acute decompensated heart failure (ADHF). However, the post-discharge trajectory of renal function in these patients remains unclear. We aimed to evaluate the rate of WRF recovery after discharge and its prognostic significance.

In a cohort of 2020 patients hospitalized for ADHF (TRI-AHF registry), serum creatinine was measured at admission, daily during hospitalization, and at 12 months after discharge. WRF was defined as a creatinine increase ≥0.3 mg/dL. Only patients who developed WRF during the index hospitalization were included. At the 12-month follow-up, WRF was classified as recovered if the change in creatinine from admission was <0.3 mg/dL, and persistent if ≥0.3 mg/dL. The primary endpoint was 5-year all-cause mortality after the 12-month creatinine reassessment.

During the study period, 331 patients (16%) experienced WRF. At 12 months, 157 (54%) had recovered WRF and 133 (46%) had persistent WRF. Older age, elevated natriuretic peptide levels, and right ventricular dysfunction during hospitalization were independent predictors of persistent WRF. At 5-year follow-up after the 12-month assessment, recovered WRF was strongly associated with a lower risk of mortality compared with persistent WRF (adjusted HR=0.229, p < 0.001). The association between WRF recovery and improved survival was independent of prior chronic kidney disease and baseline creatinine, and appeared more pronounced in males than in females (p-int=0.034).

Among patients hospitalized for ADHF who experienced WRF, 54% recovered renal function at 12 months. Recovery of WRF was associated with significantly better long-term survival compared with persistent WRF.