Change in Estimated Glomerular Filtration Rate during Hospitalization Predicts Five-Years Mortality Rate in Acute Decompensated Heart Failure: A Large Tertiary Medical Center Cohort Study

Introduction: About 63% of heart failure(HF) patients experience any renal impairment. After 1 year or more of follow-up, 38% of patients with any renal impairment and 51% with moderate-to-severe impairment died versus 24% without renal impairment.

Aim: Investigating the relationship between estimated glomerular filtration rate (eGFR) changes during hospitalization with short- and log-term five years mortality rates in acute decompensated HF patients.

Methods: A 6669 patients hospitalized with acute decompensated HF in the period 2008-2016 at the Sheba Medical Center were included. Patients were stratified according to ejection fraction(EF) a preserved EF (HFpEF; EF ≥ 50%), midrange EF (HFmrEF, EF 40-49%,) and reduced EF (HFrEF; EF<40%). The primary endpoints was defined as all-cause mortality at one- and five- years of follow-up. further Sub-division of the cohort according to eGFR (stable, decline and improved, defined by 20% or more change from baseline eGFR)was done for inquiring the relationship of long term all-cause mortality at the different LVEF categories.

Result: 4,538 HF patients (68.0%) had stable, 735 (11.0%) had improved and 1,397 (20.9%) had a decline eGFR values. Males have more stable eGFR. Diabetes was correlated with a eGFR decline (42.5% vs 38% stable and 33% improved, p<0.001).All-cause mortality rate in the entire cohort resulted 43.7% (3,324 subjects). Kaplan-Meier analysis, eGFR change during hospitalization predicted both 1-year mortality (log-rank chi-square=13.26, p=0.000), with survival being better for improved eGFR, but without any statistically significant difference between stable and decline eGFR values, and 5-year mortality (log-rank chi-square=83.49, p=0.000), with mortality rate being higher for decline eGFR values and being lower for improved eGFR values (graph). Similar trends found when stratifying according to EF values.

Conclusion: HF patients with worsened renal function showed lower one-year and five-years survival, compared to stable and improved renal function. The same trends noticed among the different EF categories.