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An old stigma in acute heart failure: worsening renal function at discharge is always a big issue?
Session:
Painel 2 - Insuficiência Cardíaca 10
Speaker:
Sofia S. Martinho
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.7 Acute Heart Failure - Other
Session Type:
Posters
FP Number:
---
Authors:
Sofia S. Martinho; José Almeida; João Rosa; Gustavo M. Campos; Patrícia M. Alves; Catia Ferreira; Flávio André Freitas; João André Ferreira; James Milner; Fátima Franco Silva; Rui Baptista; Lino Gonçalves
Abstract
<p>BACKGROUND: Deterioration of renal function in acute heart failure (AHF) occurs by renal congestion and / or low cardiac output and is an important prognostic factor in patients with AHF. We aimed to assess if worsening of renal function (WRF) at discharge in AHF was associated with a higher risk of readmission and its interaction with markers of clinical decongestion, as a negative variation of NT-proBNP levels.</p> <p>METHODS: We conducted a single-centre, retrospective, observational study of 128 patients who were admitted to our hospital for AHF during 2016 and were discharged alive. Baseline clinical, laboratory and demographic characteristics were evaluated at admission. We selected 106 patients who decreased NT-proBNP from admission to discharge and assessed whether WRF (identified as a decrease in glomerular filtration rate compared with the value on admission) alone (n=59) was associated with a higher readmission rate at 3-months. Then, we selected those who developed WRF at discharge and assessed whether worsening of NT-proBNP alone (n=10) was associated with a higher readmission rate at 3-months.</p> <p>RESULTS: Mean age was 75±12 years and 62% were male. At baseline, 95% were on clinical-haemodynamic profile B, with a median NT-proBNP of 2433 (IQR 1446-5130) pg/dL, and a mean estimated glomerular filtration rate (GFR) of 59±27mL/min/m<sup>2</sup>. At discharge, when only patients who had decreased NT-proBNP during the admission (NT-proBNP at discharge - NTproBNP at admission <0 pg/dL) were selected, those who developed WRF (GFR at discharge – GFR at admission < 0mL/min/m<sup>2</sup>) did not have an increased risk of AHF readmission at 3-months compared to those who did not develop WRF [OR 1.5 (95% CI 0.6 to 3.8, p=0.417]. Conversely, when we selected only patients who developed WRF at discharge, an elevation of NT-proBNP was associated with a higher risk for AHF readmission at 3-months [HR 3.6 ( 95% CI 1.5 to 8.7, Log Rank p=0.005)], after adjusting for age and gender.</p> <p>CONCLUSIONS: After an AHF admission, the major prognostic factor of 3-months readmission was the presence of residual congestion, signalled by an increase in NT-proBNP, regardless of whether renal function worsens at discharge. Efforts should be made to achieve as much decongestion as possible, even if it results in acute worsening of renal function.</p>
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