Worsening renal function in acute heart failure in the context of diuretic response

Emmens, J. E. et al. (2022) Worsening renal function in acute heart failure in the context of diuretic response. European Journal of Heart Failure, 24(2), pp. 365-374. (doi: 10.1002/ejhf.2384) (PMID:34786794)

[img] Text
258992.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial.

[img] Text
258992Suppl.pdf - Supplemental Material



Background: For patients with acute heart failure (AHF), substantial diuresis after administration of loop diuretics is generally associated with better clinical outcomes but may cause creatinine to rise, suggesting renal function decline. We investigated the interaction between diuretic response and worsening renal function (WRF) on clinical outcomes in patients with AHF. Methods and results: In two AHF cohorts (PROTECT, n=1,698 and RELAX-AHF-2, n=5,586 in current analysis), the prognostic impact of WRF (creatinine ≥0.3 mg/dL increase baseline–day 4; sensitivity analyses incorporated baseline renal function) by diuretic response (kg weight loss/40 mg furosemide equivalent baseline–day 4) was investigated with regards to (CV) death or cardiovascular/renal hospitalisation using subpopulation treatment effect pattern plots (STEPP) and survival analyses. WRF occurred in 286(16.8%) and 1,031(18.5%) patients in PROTECT and RELAX-AHF-2 respectively. Patients with WRF had higher left ventricular ejection fraction and lower estimated glomerular filtration rate at baseline (P<0.05), and received higher doses of loop diuretics and had a worse diuretic response (P<0.001). In patients with a poor diuretic response (≤0.35 kg weight loss/40 mg furosemide equivalent as identified by STEPP), WRF was associated with higher risk of (CV) death or cardiovascular/renal hospitalisation (P<0.001 both cohorts), but this was not the case for patients with a good diuretic response (P=0.900 both cohorts). Conclusion: In two large cohorts of patients with AHF, WRF in the first 4 days was not associated with worse outcomes when patients had a good diuretic response. The occurrence of WRF in patients with AHF should therefore be considered in the context of diuretic response.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Emmens, J. E., ter Maaten, J. M., Matsue, Y., Figarska, S. M., Sama, I. E., Cotter, G., Cleland, J. G.F., Davison, B. A., Felker, G. M., Givertz, M. M., Greenberg, B., Pang, P. S., Severin, T., Gimpelewicz, C., Metra, M., Voors, A. A., and Teerlink, J. R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:17 November 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in European Journal of Heart Failure 24(2): 365-374
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record