e64 Circulation: Heart Failure Topic Review Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure? The Role of Congestion and Its Interaction With Renal Function

Summary: An increase in serum creatinine, generally defined as worsening renal function (WRF), is considered an ominous prognos-tic sign in patients with heart failure (HF). However, an increase in serum creatinine may be caused by a relative dehydration second-ary to overdiuresis. Thus, the prognostic significance of WRF may depend on the patient’s volume status. To ascertain this, the authors measured serum creatinine levels on a daily basis during hospitaliza-tion and assessed the persistence of signs of congestion at discharge in 599 consecutive patients admitted at our institute for acute HF. Patients with WRF and no congestion had similar outcomes com-pared with those with no WRF and no congestion, whereas the risk of death or of death or HF readmission was increased in the patients with persistent congestion alone and in those with both WRF and congestion. The data show that WRF has an additive prognostic value only when it occurs in patients with persistent signs of congestion. Accordingly, the serum creatinine changes occurring in the absence of congestion should not influence treatment of HF, hospitalization length, and/or be target of HF treatment. Conclusions: WRF alone, when detected using serial serum creati-nine measurements, is not an independent determinant of outcomes in patients with AHF. It has an additive prognostic value when it occurs in patients with persistent signs of congestion.