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Worsening of Renal Function Among Hospitalized Patients With Acute Heart Failure

Phenotyping, Outcomes, and Predictors
  • Xin He
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Bin Dong
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Weihao Liang
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Ruicong Xue
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Jingjing Zhao
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Zexuan Wu
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Fangfei Wei
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Peisen Huang
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Wengen Zhu
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Jiangui He
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Yugang Dong
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
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  • Michael Fu
    Affiliations
    Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
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  • Chen Liu
    Correspondence
    Correspondence: Address to Chen Liu, MD, PhD, Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, China, 510080.
    Affiliations
    Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
    Search for articles by this author

      Abstract

      Objective

      To define clinical phenotyping and its associated outcome of worsening of renal function (WRF) in hospitalized acute heart failure (AHF) patients.

      Patients and Methods

      Latent class analysis was performed in 113 AHF patients who developed WRF within 72 hours in the DOSE (Diuretic Optimization Strategies Evaluation) trial (from March 2008 to November 2009) and ROSE-AHF (Renal Optimization Strategies Evaluation in Acute Heart Failure) trial (from September 2010 to March 2013) to identify potential WRF phenotypes. Clinical characteristics and outcome (in-hospital and post-discharge) were compared between different phenotypes.

      Results

      Two WRF phenotypes were identified by latent class analysis, which we named WRF minimally responsive to diuretics (WRF-MRD) and WRF responsive to diuretics (WRF-RD). Among the population, 58 (9.5%) developed WRF-MRD and 55 (9.0%) developed WRF-RD. Patients with WRF-MRD had more comorbidities than WRF-RD. In WRF-MRD, there were an early increase in serum creatinine, a smaller amount of net fluid loss and weight loss, and a higher rate of worsening or persistent heart failure over 72 hours. In contrast, for those with WRF-RD, they had faster in-hospital net fluid loss and weight loss and a better 60-day survival after discharge even compared with patients without WRF (P=.004). Furthermore, baseline chronic obstructive pulmonary disease, diabetes, and cystatin C were independent predictors of WRF-MRD, whereas serum hemoglobin and sodium predicted WRF-RD.

      Conclusions

      Among hospitalized AHF patients, we identified two phenotypes of WRF with distinct response to heart failure treatment, predictors, and short-term prognosis after discharge. The results could help early differentiation of WRF phenotypes in clinical practice.

      Abbreviations and Acronyms:

      ACEI (angiotensin-converting enzyme inhibitor), AHF (acute heart failure), ARB (angiotensin-receptor blocker), BUN (blood urea nitrogen), COPD (chronic obstructive pulmonary disease), EF (ejection fraction), GFR (glomerular filtration rate), JVP (jugular venous pressure), LCA (latent class analysis), NT-proBNP (N-terminal pro-brain natriuretic peptide), SBP (systolic blood pressure), WRF (worsening of renal function), WRF-RD (worsening of renal function responsive to diuretics), WRF-MRD (worsening of renal function minimally responsive to diuretics)
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      Linked Article

      • Diuretic Resistance—A Key to Identifying Clinically Significant Worsening Renal Function in Heart Failure?
        Mayo Clinic ProceedingsVol. 97Issue 9
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          Worsening renal function (WRF) in patients hospitalized with acute heart failure (AHF) presents a frequent clinical dilemma that is compounded by the inconsistent results of studies seeking to determine whether WRF in AHF is associated with worse clinical outcomes, such as death or readmission. More recent studies suggest that when serum creatinine concentration rises from a hemodynamic process such as appropriate blood pressure lowering or decongestion, WRF is no longer associated with adverse outcomes.
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