Publication: Association of left ventricular ejection fraction with worsening renal function in patients with acute heart failure: insights from the RELAX-AHF-2 study
Issued Date
2021-01-01
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ISSN
18790844
13889842
13889842
Other identifier(s)
2-s2.0-85092163003
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Mahidol University
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SCOPUS
Bibliographic Citation
European Journal of Heart Failure. Vol.23, No.1 (2021), 58-67
Suggested Citation
Siting Feng, Satit Janwanishstaporn, John R. Teerlink, Marco Metra, Gad Cotter, Beth Davison, G. Michael Felker, Gerasimos Filippatos, Peter Pang, Piotr Ponikowski, Iziah E. Sama, Adriaan A. Voors, Barry Greenberg Association of left ventricular ejection fraction with worsening renal function in patients with acute heart failure: insights from the RELAX-AHF-2 study. European Journal of Heart Failure. Vol.23, No.1 (2021), 58-67. doi:10.1002/ejhf.2012 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78887
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Title
Association of left ventricular ejection fraction with worsening renal function in patients with acute heart failure: insights from the RELAX-AHF-2 study
Other Contributor(s)
San Francisco VA Health Care System
Momentum Research, Inc
Beijing Anzhen Hospital, Capital Medical University
University of Cyprus
School of Medicine
Indiana University School of Medicine
Università degli Studi di Brescia
Faculty of Medicine Siriraj Hospital, Mahidol University
Rijksuniversiteit Groningen
Wroclaw Medical University
David Geffen School of Medicine at UCLA
Duke University School of Medicine
Momentum Research, Inc
Beijing Anzhen Hospital, Capital Medical University
University of Cyprus
School of Medicine
Indiana University School of Medicine
Università degli Studi di Brescia
Faculty of Medicine Siriraj Hospital, Mahidol University
Rijksuniversiteit Groningen
Wroclaw Medical University
David Geffen School of Medicine at UCLA
Duke University School of Medicine
Abstract
Aims: Whether risk of worsening renal function (WRF) during acute heart failure (AHF) hospitalization or the association between in-hospital WRF and post-discharge outcomes vary according to left ventricular ejection fraction (LVEF) is uncertain. We assessed incidence of WRF, factors related to its development and impact of WRF on post-discharge outcomes across the spectrum of LVEF in patients enrolled in RELAX-AHF-2. Methods and results: A total of 6112 patients who had LVEF measured on admission and renal function determined prospectively during hospitalization were included. WRF, defined as a rise in serum creatinine ≥0.3 mg/dL from baseline through day 5, occurred in 1722 patients (28.2%). Incidence increased progressively from lowest to highest LVEF quartile (P < 0.001). After baseline adjustment, WRF risk in Q4 (LVEF >50%) remained significantly greater than in Q1 (LVEF ≤29%; hazard ratio 1.2, 95% confidence interval 1–1.43; P = 0.050). Age and comorbidity burden including chronic kidney disease increased as LVEF increased. Neither admission haemodynamic abnormalities, extent of diuresis during hospitalization nor residual congestion explained the increased incidence of WRF in patients with higher LVEF. Serelaxin treatment and diuretic responsiveness were associated with reduced risk of WRF in all LVEF quartiles. WRF in patients in the upper three LVEF quartiles increased risk of post-discharge events. Conclusions: Worsening renal function incidence during AHF hospitalization increases progressively with LVEF. Greater susceptibility of patients with higher LVEF to WRF appears more related to their advanced age and worse underlying kidney function rather than haemodynamic or treatment effects. WRF is associated with increased risk of post-discharge events except in patients in the lowest LVEF quartile.