Trajectories of changes in renal function in patients with acute heart failure

Aims: Changes in renal function have been associated with differential outcome in patients with acute heart failure (HF). However, individual trajectories of changes in renal function are unknown and it is unclear whether these relate to different clinical characteristics and clinical outcome. Our aim was to investigate the prognostic importance of individual trajectories of changes in renal function in acute HF. Methods and Results: This was a retrospective, observational analysis from the double-blind, randomized, placebo controlled PROTECT trial in acute HF patients. We identified and internally validated 8 different renal trajectories among 1897 patients by visual inspection of inhospital serum creatinine changes. The primary outcome measure was all-cause mortality at 180 days. Mean age was 70±12 years, 70% were male, and mean baseline eGFR was 49.0 mL/min/1.73m2. A total of eight different trajectories were established. The most prevalent trajectories were an inhospital bump (19.0%), a sustained increase (17.6%), and a dip (14.5%) in serum creatinine. Overall, clinical characteristics of patients within different trajectories were remarkably similar. Crude 180-day mortality rates ranged from 12.0% in the trajectory with no significant changes to 18.3% in trajectory of sustained increase without significant differences. Overall, after multivariable adjustment, there was no trajectory of changes in renal function that was associated with significantly better or worse outcomes. Conclusions: Trajectories of changes in renal function in acute HF differ considerably on patient level. Despite these differences, clinical characteristics and outcome were similar, therefore questioning the prognostic importance of changes in renal function in acute HF