Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance

Eur J Heart Fail. 2008 Feb;10(2):188-95. doi: 10.1016/j.ejheart.2008.01.011.


Background: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF).

Methods and results: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a > or =25% and a > or =0.3 mg/dL increase in serum creatinine (s-Cr) from admission (WRF-Abs-%).

Results: Patients were followed for 480+/-363 days. Fifty-three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF-Abs-% occurred in 107 (34%) patients. At multivariable survival analysis, WRF-Abs-% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13-1.81; p=0.024). The independent predictors of WRF-Abs-%, evaluated using multivariable logistic regression, were history of chronic kidney disease (p=0.002), LV ejection fraction (p=0.012), furosemide daily dose (p=0.03) and NYHA class (p=0.05) on admission.

Conclusion: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.

MeSH terms

  • Aged
  • Creatinine / blood
  • Diuretics / administration & dosage
  • Female
  • Furosemide / administration & dosage
  • Heart Failure / mortality
  • Heart Failure / physiopathology*
  • Hospitalization
  • Humans
  • Kidney / physiopathology*
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Survival Analysis


  • Diuretics
  • Furosemide
  • Creatinine