Worsening Renal Function in Acute Decompensated Systolic Heart Failure; Observations from RASHF Registry, an Iranian Heart Failure Registry

Background: Heart Failure (HF) is a major cause of morbidity and mortality worldwide. Additionally, Worsening Renal Function (WRF) during hospitalization has a significant effect on re-hospitalization and mortality in such patients.
Objectives: The present study aimed to determine the prevalence and prognostic significance of WRF complicating acute HF in patients enrolled into Rajaie Acute Systolic Heart Failure (RASHF) registry.
Patients and Methods: RASHF registry is a single-center, prospective, observational, hospital-based study of systolic HF patients with Left Ventricular Ejection Fraction (LVEF) ≤ 35% admitted with acute decompensation. The patients were enrolled for 10 months from March 2012 to February 2013. The primary endpoint of the study was WRF. In addition, the secondary endpoints were in-hospital mortality and death within 3 months after discharge.
Results: This study was performed on 230 patients (82% male). About one thirds of the patients (29.1%) developed WRF. Although some characteristics of the patients with WRF, including etiology of HF, NYHA functional class, and presence of risk factors, were similar to those of other patients, they were older, had more congestive symptoms, and had higher baseline creatinine levels. The incidence of in-hospital mortality was 9.6%. Length of hospital stay (14 days versus 8 days, P < 0.001), in-hospital mortality (23.9% versus 4.9%, P < 0.001), and death during 3 months after discharge (19.4% versus 13.4%, P < 0.001) were higher among the patients with WRF.
Conclusions: WRF was quite common in the patients with Acute Heart Failure (AHF) and was associated with higher in-hospital mortality and decrease in early survival after discharge.