Prognostic implications of renal function trajectories in heart failure management

A.Z. Y., Koh and B. K., Chung and Hwei Sung, Ling and C. Z. F., Chua and W. K., Ho and K. C., Cheah and S. L., Kwa and J., Namasoo and C. H., ChaI and P. W., Ting and M. J., Khaw and J. K. W., Wong and L. Y., Ting and S. Y., Chai and R.S.L., Chew (2025) Prognostic implications of renal function trajectories in heart failure management. European Journal of Heart Failure, 27 (Supp.2). p. 84. ISSN 1879-0844

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Abstract

Introduction: The interaction between the heart and kidneys, known as cardiorenal syndrome, means that worsening renal function (WRF) in heart failure can lead to a vicious cycle, where declining renal function further impairs cardiac performance. Monitoring and managing WRF in heart failure is crucial, as it is associated with poorer prognosis, increased hospitalization rates, and higher mortality. Purpose: This study is to compare baseline characteristics, treatment regimens, and clinical outcomes in HF patients with WRF versus those with stable or improved renal function at first visit to HF clinic. Methods: This retrospective cohort study involved 343 HF patients with HFrEF across 10 hospitals from January 2021 to June 2023. WRF is defined by increase in serum creatinine at first HF clinic visit by ≥26.5 μmol/L from baseline or an increase of ≥25% from baseline values. Patients were categorized into WRF (n = 49, 14.3%) and stable/improved renal function (n = 294, 85.7%). Comparative analysis included demographics, comorbidities, medication use, ejection fraction [EF], NYHA class and clinical outcomes (HF hospitalization, mortality, and composite outcomes). Results: Patients with WRF were slightly older (58.8 ± 14.9 years) than those with stable/improved function (56.5 ± 13.6 years, p = 0.280). Comorbidities such as hypertension (77.6% vs. 65.2%, p = 0.089) and dyslipidaemia (65.3% vs. 51.7%, p = 0.077) were more prevalent in the WRF group. At first visit, renin-angiotensin-aldosterone system inhibitors (RAAS) use was lower in the WRF group (68.8% vs. 84.4%, p = 0.009) but higher beta-blocker use (97.9% vs. 90.1%, p = 0.077). Mineralocorticoid receptor antagonists (MRA), sodium-glucose cotransporter-2 (SGLT2) inhibitor and frusemide use were comparable in both groups. There was no difference with HF medications prescription at 3 months. The WRF group showed significant EF improvement (24.3 ± 4.6% to 41.8 ± 9.7%, p = 0.019), whereas the stable/improved group had a non-significant change (26.5 ± 8.0% to 33.7 ± 12.7%, p = 0.315). The WRF group had a higher composite outcome rate at 3 months (22.9% vs. 7.6%, p < 0.001), HF hospitalization at 3 months (16.3% vs. 5.8%, p = 0.02) and mortality at 3 months (8.5% vs. 2.2%, p = 0.037). Conclusion: HF patients with WRF experienced greater EF improvement but higher hospitalization and adverse outcomes. Close monitoring and optimizing renal function are vital in HF management to improve patient outcomes.

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