Outcome in acute heart failure: prognostic value of acute kidney injury and worsening renal function

J Card Fail. 2015 May;21(5):382-390. doi: 10.1016/j.cardfail.2014.12.015. Epub 2015 Jan 7.


Background: The prognostic value of worsening renal function (WRF) in acute heart failure is debated. Moreover, it is not clear if the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this context is detrimental.

Method and results: In a retrospective cohort study of 646 patients hospitalized for acute heart failure, the risk of death or readmission associated with acute kidney injury (AKI) present at admission, WRF during the 1st 7 days, and up-titration of ACEI/ARB were analyzed in a Cox proportional hazards model. AKI, WRF, hemoglobin concentration, ACEI/ARB up-titration, and use of loop diuretics before admission were significantly associated with the primary outcome in univariate analysis. In a multivariate model, the association remained significant for AKI (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13-1.47; P = .0002), WRF (HR 1.24, 95% CI 1.06-1.45; P = .0059), and ACEI/ARB up-titration (HR 0.79, 95% CI 0.64-0.97; P = .026). There was no excess mortality in patients with ACEI/ARB up-titration despite WRF.

Conclusions: Both AKI and WRF are strongly associated with poor outcome in patients hospitalized for acute heart failure. ACEI/ARB up-titration seems to be protective.

Keywords: ACEI/ARB up-titration; Worsening renal function; acute heart failure; death; prognosis; readmission.

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / physiopathology
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology
  • Heart Failure / diagnosis*
  • Heart Failure / epidemiology*
  • Heart Failure / physiopathology
  • Humans
  • Kidney Function Tests / trends*
  • Male
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome