Functional kidney state in patients with decompensated heart failure: annual outpatient follow-up results

Objective: to analyze the frequency and risk factors for the development or progression of chronic kidney disease (CKD) during the year following acute decompensated heart failure (ADHF), to assess the role of kidney damage patterns identified during hospitalization in the development of composite renal and cardiovascular outcomes.

Materials and methods: patients with ADHF and documented serum creatinine levels within the 3 months preceding hospitalization were included. Patients with CKD stage 4, 5 or advanced heart failure (HF) who were unable to undergo outpatient follow-up were included. Composite renal outcome: rapid progression, de novo development or stage progression of CKD. Composite cardiovascular outcome: all-cause mortality or rehospitalizations for ADHF. Physical, laboratory, and instrumental examinations were performed.

Results: A total of 108 patients were enrolled. Of these, 60% were men; mean age 71 (61-75) years, left ventricle ejection fraction was 45% (35-53%). The prevalence of comorbities was: arterial hypertension (AH) 92%, diabetes mellitus (DM) 35%, and CKD 26%. During hospitalization 47% had an estimated GFR < 60 ml/min/1.73 m².

The incidence of composite renal outcomes was 42%. Specifically, stage progression of CKD in 29% (n=13), de novo CKD in 46% (n=21), rapid progression in 49% (n=22), and isolated rapid progression (decline in GFR within the CKD stage) in 25% (n=11).

Logistic regression identified the following independent risk factors for adverse renal outcomes: prior history of CKD (HR– 8.7, 95% CI 2.2 – 35, p=0.002), venous congestion discharge (VExUS) (HR 5.5, 95% CI 1.5 – 20, p=0.008), loop diuretic dose >40 mg/day at discharge (HR – 4.2, 95% CI 1.3 – 13, p=0.012), elevated NT-proBNP at discharge (HR 4.2, 95% CI 1.2 – 15, p=0.025), serum uric acid >360 mmol/l on admission (HR – 4.1, 95% CI 1.4 – 12, p=0.009), loop diuretic dose >80 mg/day on admission (HR 3.7, 95% CI 1.2 – 11, p=0.019), acute kidney disease (AKD) during hospitalization (HR – 3.6, 95% CI 1.3 – 10, p=0.017), serum urea >8.3 mmol/l on admission (HR – 3.1, 95% CI 1 – 9, p=0.037), and higher median of age (HR 1.1, 95% CI 1 – 1.1, p=0.017).

The incidence of composite cardiovascular outcomes was 38%. Kaplan-Meyer curves demonstrated poorer cardiovascular outcomes in the AKI/AKD group compared with groups with patients with stable CKD or no kidney pathology (log-rank p=0.02).

Conclusion: composite renal outcome events occurred in 42% of participants. The most significant risk factors were a history of CKD and HF-related congestion. Cardiovascular outcomes were more frequent in patients with AKI/AKD than in those with stable CKD or no kidney disease.

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