Int J Heart Fail.  2021 Apr;3(2):128-137. 10.36628/ijhf.2020.0050.

Clinical Impact of Worsening Renal Function in Elderly Patients with Acute Decompensated Heart Failure

• Sawamura A
• Kajiura H
• Sumi T
• Umemoto N
• Sugiura T
• Taniguchi T
• Ohashi M
• Asai T
• Shimizu K
• Murohara T

• KMID: 2532581
• DOI: http://doi.org/10.36628/ijhf.2020.0050

Abstract

Background and Objectives
The clinical significance of worsening renal function (WRF) in elderly patients with acute decompensated heart failure (ADHF) is not completely understood. We compared the clinical conditions between younger and elderly patients with ADHF after the appearance of WRF to establish its prognostic influence.
Methods
We included 654 consecutive patients (37% women) admitted for ADHF. We divided the patients into four groups according to their age (<80 years, under-80, n=331; ≥80 years, over-80, n=323) and to their WRF statuses (either WRF or non-WRF group). We defined WRF as an increase in serum creatinine level ≥0.3 mg/dL or ≥150% within 48 hours after hospital arrival (under-80, n=62; over-80, n=75). The primary endpoint was a composite of cardiac events within 1 year.
Results
The survival analyses revealed that the WRF group had significantly more cardiac events than the non-WRF group in patients in the over-80 group (log-rank p=0.025), but not in those of the under-80 group (log-rank p=0.50). The patients in the over-80, WRF group presented more significant mean blood pressure (MBP) drops than those in the over-80 nonWRF group (p=0.003). Logistic regression analyses revealed that higher MBP at admission was a significant predictor of WRF.
Conclusions
WRF is a predictor of poor outcomes in elderly patients with ADHF.

Keyword

Aged; Heart failure; Cardio-Renal syndrome