Association between Left Ventricular Ejection Fraction and Worsening Renal Function in Acute Heart Failure: Insights from the RELAX-AHF-2 Trial

BackgroundWorsening renal function (WRF) occurs commonly during episodes of acute heart failure (AHF). However, the association between left ventricular ejection fraction (LVEF) and WRF in patients with AHF is uncertain. Consequently, we assessed the development of WRF over a broad range of LVEF in patients with a broad range of LVEF who were hospitalized with AHF.MethodsWe analyzed data from 6,128 patients enrolled in the in RELAX-AHF 2 trial who had LVEF measured during AHF hospitalization. Patients were categorized in quartiles according to LVEF: Q1, LVEF 7-29%; Q2, LVEF 29-38%; Q3, LVEF 38-50% and Q4, LVEF 50-87%. WRF was defined as a rise in serum creatinine of ≥0.3 mg/dL from baseline through day 5 in the hospital.ResultsThe incidence of WRF through hospital day 5 was higher in the HFpEF cohort (Q4) compared with the lowest LVEF group (Q1) (34.3% vs. 23%; OR 1.94, 95%CI 1.52-2.48, P<0.001) and this difference persisted after multivariate analysis (adjusted OR 1.36, 95%CI 1.01-1.83, p=0.042) (Figure 1 and Table 1). Notably, weight loss was significantly less in Q4 than in Q1 patients (weight kg Median: 3.18 vs. 3.95, P<0.001). HFpEF patients (Q4) also demonstrated more evidence of residual congestion (clinical congestion [any sign/symptom of edema (35.1% vs. 32.3%), high JVP (9.0% vs. 6.8%), orthopnea (16.8% vs. 15.2%)] at day 5 compared to HFrEF patients(Q1).ConclusionsWRF during AHF hospitalization was higher in HFpEF than in HFrEF patients. Evidence of a lower weight loss and persistence of residual congestion in HFpEF vs HFrEF patients were factors associated with WRF in HFpEF group. These findings demonstrate that HFpEF patients are more likely to develop WRF during AHF hospitalization than HFrEF patients and they suggest that residual congestion may play a role in this process. Worsening renal function (WRF) occurs commonly during episodes of acute heart failure (AHF). However, the association between left ventricular ejection fraction (LVEF) and WRF in patients with AHF is uncertain. Consequently, we assessed the development of WRF over a broad range of LVEF in patients with a broad range of LVEF who were hospitalized with AHF. We analyzed data from 6,128 patients enrolled in the in RELAX-AHF 2 trial who had LVEF measured during AHF hospitalization. Patients were categorized in quartiles according to LVEF: Q1, LVEF 7-29%; Q2, LVEF 29-38%; Q3, LVEF 38-50% and Q4, LVEF 50-87%. WRF was defined as a rise in serum creatinine of ≥0.3 mg/dL from baseline through day 5 in the hospital. The incidence of WRF through hospital day 5 was higher in the HFpEF cohort (Q4) compared with the lowest LVEF group (Q1) (34.3% vs. 23%; OR 1.94, 95%CI 1.52-2.48, P<0.001) and this difference persisted after multivariate analysis (adjusted OR 1.36, 95%CI 1.01-1.83, p=0.042) (Figure 1 and Table 1). Notably, weight loss was significantly less in Q4 than in Q1 patients (weight kg Median: 3.18 vs. 3.95, P<0.001). HFpEF patients (Q4) also demonstrated more evidence of residual congestion (clinical congestion [any sign/symptom of edema (35.1% vs. 32.3%), high JVP (9.0% vs. 6.8%), orthopnea (16.8% vs. 15.2%)] at day 5 compared to HFrEF patients(Q1). WRF during AHF hospitalization was higher in HFpEF than in HFrEF patients. Evidence of a lower weight loss and persistence of residual congestion in HFpEF vs HFrEF patients were factors associated with WRF in HFpEF group. These findings demonstrate that HFpEF patients are more likely to develop WRF during AHF hospitalization than HFrEF patients and they suggest that residual congestion may play a role in this process.