Renal function at discharge matters: graded prognostic impact of kidney dysfunction after decompensated heart failure with reduced ejection fraction
S Valdivielso, M Cainzos-Achirica, L C Belarte-Tornero, M Vicente Elcano, B Ayala-Borges, J Vime-Jubany, N Badosa-Merce, F Martinez Medina, I Garcia-Nunez, P Ruiz Rodriguez, A Linas Alonso, G Torres-Padilla, C Loaiza-Herrera, A Miralles-Morante, S Ruiz-BustilloAbstract
Background/Introduction
Renal dysfunction is a frequent comorbidity in patients with heart failure (HF) and is consistently associated with adverse outcomes. However, the clinical profile associated with different degrees of renal impairment and the prognostic implications across glomerular filtration rate (GFR) categories in patients with HF and left ventricular ejection fraction (LVEF) >40% remain incompletely characterized.
Purpose
To identify baseline clinical characteristics associated with worse renal function at hospital discharge and to evaluate the graded impact of renal dysfunction on one-year outcomes in patients hospitalized for acute decompensated HF with LVEF >40%.
Methods
We analysed consecutive patients admitted for acute decompensated HF between July 2018 and June 2024 with LVEF >40%. Renal function at discharge was categorized according to estimated glomerular filtration rate (GFR ?60, 45–60, 30–45, and <30 mL/min/1.73 m²). Baseline demographic characteristics, cardiovascular risk factors, comorbidities, and HF- related history were compared across GFR categories to identify variables associated with worse renal function. One-year outcomes included all-cause rehospitalization, all-cause mortality, and a composite endpoint. Multivariable logistic regression models were sequentially adjusted for age, sex, socioeconomic factors, and cardiovascular risk factors.
Results
Among 559 patients included, progressively worse renal function was associated with an older age and higher prevalence of cardiovascular risk factors (hypertension, diabetes and dyslipemia). No significant differences were observed in sex distribution or most comorbidities, except for a higher prevalence of prior stroke and chronic kidney disease (GFR <60 mL/min/1.73 m²). Among cardiovascular history, prior heart failure was associated with worse renal function at discharge.
At one year, rates of rehospitalization, mortality, and composite events increased significantly with declining GFR (p<0.01). After adjustment for age and sex, patients with GFR <30 mL/min/1.73 m² had a higher risk of rehospitalization (OR 2.29, 95% CI 1.38–3.80), mortality (OR 2.54, 95% CI 1.34–4.81), and composite events (OR 2.53, 95% CI 1.54–4.15) compared with those with GFR ?60. These associations remained significant after further multivariable adjustment.
Conclusions
In patients with recent decompensated HF with LVEF >40%, distinct baseline clinical profiles are associated with worse renal function at discharge. Furthermore, the severity of renal dysfunction confers a graded and independent prognostic impact on one-year outcomes, underscoring renal function at dischargeFor image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.