Renal Function Trajectories and Clinical Outcomes in Acute Heart Failure.
Circ Heart Fail. 2013 Nov 26;
Authors: Givertz MM, Postmus D, Hillege HL, Mansoor GA, Massie BM, Davison BA, Ponikowski P, Metra M, Teerlink JR, Cleland JG, Dittrich HC, O'Connor CM, Cotter G, Voors AA
BACKGROUND: -Prior studies have demonstrated adverse risk associated with baseline and worsening renal function in acute heart failure (AHF), but none has modeled the trajectories of change in renal function and their impact on outcomes.
METHODS AND RESULTS: -We used linear mixed models of serial measurements of BUN and creatinine (Cr) to describe trajectories of renal function in 1,962 patients with AHF and renal dysfunction enrolled in the PROTECT study. We assessed risk of 180-day mortality and 60-day cardiovascular or renal readmission, and used Cox regression to determine association between renal trajectories and outcomes. Compared to patients alive at 180 days, patients who died were older, had lower blood pressure and ejection fraction, and higher Cr levels at baseline. On average for the entire cohort, Cr rose from days 1 to 3 and increased further after discharge, with the trajectory dependent on the day of discharge. BUN, Cr and the rate of change in Cr from baseline were the strongest independent predictors of 180-day mortality and 60-day readmission, while the rate of change of BUN from baseline was not predictive of outcomes. Baseline BUN >35 mg/dl and increase in Cr >0.1 mg/dl per day increased the risk of mortality, while stable or decreasing Cr was associated with reduced risk.
CONCLUSIONS: -Patients with AHF and renal dysfunction demonstrate variable rise and fall in renal indices during and immediately following hospitalization. Risk of morbidity and mortality can be predicted based on baseline renal function and creatinine trajectory over the first 7 days. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00328692 and NCT00354458.
PMID: 24281137 [PubMed - as supplied by publisher]