Predictors and Prognosis of Worsening Renal Function in Patients with Diastolic Heart Failure Hospitalized with Acute Heart Failure and Treated with Intravenous Furosemide

Background:

The purpose of this study was to assess the predictors and prognosis of worsening renal function (WRF) in patients hospitalized with acute diastolic heart failure.

Methods:

We retrospectively evaluated 149 patients who were admitted with acute diastolic heart failure at Regions Hospital from April 2004 to September 2008. All patients received intravenous (IV) furosemide therapy during their hospital stays, and the dose was determined at the discretion of the treating clinician. WRF was defined as an increase ≥ 0.3 mg/dL in serum creatinine compared with the admission value. The combined primary end point (cardiovascular mortality, myocardial infarction, or heart failure–related rehospitalization at 1 year) was determined 1 year after the index hospitalization. Statistical analyses were performed with the X² test, the t test, and multiple logistic regression analysis. A P < 0.05 was considered significant.

Results:

The mean age of patients was 71 ± 12 years, and 66% were male. The mean admission creatinine and BNP were 1.13 ± 0.39 mg/dL and 267 ± 117.6 pg/mL respectively. Twenty‐three percent of patients had diabetes, 61% had hypertension, 40% had BMI ≥ 30 kg/m² (obesity), and 27% had stage 2–4 chronic kidney disease (CKD). Thirty‐six percent of patients were receiving either an ACE inhibitor or an ARB. Twenty‐four percent of patients had a systolic blood pressure (SBP) ≥ 180 mm Hg, and 9% had SBP ≤ 90 mm Hg al admission. The mean dose of IV furosemide was 64.7 ± 18.4 mg/day, Thirty–eight patients (25.5%) developed WRF during their hospital stays. Univariate analysis showed age ≥ 75 years, diabetes, obesity, SBP ≥ 180 mmHg, and CKD to be predictors of WRF (P < 0.05). After adjusting for age and sex. multivariate analysis showed 2 variables to be independent risk factors for WRF: (1) obesity (OR 3.7, 95% Cl 2.3–8.9, P = 0.01) and (2) CKD (OR 3.6, 95% Cl 1.4–7.9, P = 0.005). WRF during hospitalization was found to be associated with an increased risk for the combined primary end point at 1 year (OR 2.67; 95% Cl 1.94–9.7, P = 0.01).

Conclusions:

Obesity and CKD were found to be independent risk factors of WRF in patients with acute diastolic heart failure treated with intravenous furosemide. WRF during index hospitalization was associated with poor prognosis.

Author Disclosure:

I. Ahmed, none; W. Nelson, none; C. House, none; R. Dahiya, none; D. Zhu, none.