Worsening renal function in acute heart failure: the impact on subsequent kidney function and its association with haemoconcentration

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Abstract Background Worsening renal function (WRF) in acute heart failure (AHF) has traditionally been associated with poor outcomes. However, when adequate decongestion is achieved with haemoconcentration, it does not necessarily lead to adverse outcomes. Nevertheless, its impact on kidney disease progression remains unclear. Purpose To investigate the impact of WRF occurring during hospitalisation for AHF on subsequent kidney function and its association with haemoconcentration. Methods In this multicentre study, a total of 2,556 hospitalised patients with AHF (median age, 80 years; 60% male) were categorised into four groups based on the presence of WRF and haemoconcentration. WRF was defined as a ≥20% decrease in estimated glomerular filtration rate (eGFR) between admission and discharge. Haemoconcentration was defined as an increase in haemoglobin levels between admission and discharge. The primary outcome was a composite of the initiation of maintenance dialysis, a decline in eGFR to <10 ml/min/1.73 m2, or a ≥40% reduction in eGFR within one year after discharge. Additionally, longitudinal changes in kidney function were assessed using a linear mixed model. Results Kaplan–Meier curve analysis showed that patients with WRF and haemoconcentration had the highest event-free survival rate for the composite outcome among the four groups (Figure 1). In a multivariable analysis, the occurrence of WRF and haemoconcentration was significantly associated with a lower risk of the composite outcome, even after adjusting for confounders including eGFR and haemoglobin (hazard ratio, 0.52; 95% confidence interval, 0.30 to 0.90; P=0.019). In the linear mixed model, patients with WRF and haemoconcentration exhibited renal function recovery at three months, which was maintained for up to one year (Figure 2). Conclusions The impact of WRF on subsequent kidney function differed depending on the presence of haemoconcentration during hospitalisation. WRF with haemoconcentration appeared to represent a transient decline in kidney function during decongestive therapy, supporting the concept of "pseudo-WRF".Figure 1 Figure 2

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