Worsening Renal Function and Outcome in Heart Failure Patients With Preserved Ejection Fraction and the Impact of Angiotensin Receptor Blocker Treatment

Damman, Kevin; Pérez, Ana Cristina Martín; Anand, Inder S.; Komajda, Michel; McKelvie, Robert S.; Zile, Michael R.; Massie, B.M.; Carson, Peter E.; McMurray, John J.V.

doi:10.1016/j.jacc.2014.01.087

Cited by 70 publications

(73 citation statements)

References 23 publications

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“…For example, a recent study showed that WRF induced by initiating renin-angiotensin-aldosterone system inhibitors was associated with a poor prognosis in those with HFpEF, not with HFrEF. 27 In another study, although WRF was established as a predictor of poor prognosis in patients, the association was less evident in patients with HFpEF. 1 The diversity in the causes of WRF and the pathology of heart failure may explain these findings.…”

Section: Discussionmentioning

confidence: 96%

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Takei

Kohsaka

Shiraishi

et al. 2015

Circ: Heart Failure

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Background-The prognostic relevance of plasma volume reduction (PVR) in acute heart failure patients remains unclear because of the confounding hemodynamic effect of left ventricular ejection fraction impairment on kidney function. Methods and Results-Subjects enrolled in the West Tokyo Heart Failure Registry were examined. The PV at admission and discharge was estimated from the subjects' body weight and its deviation from the ideal body weight. Patients in the top tertile of estimated PVR were classified as PVR+. Of the 381 patients with acute heart failure, 181 (47.5%) had heart failure with preserved ejection fraction (HFpEF). Estimated PVR was associated with worsening renal function in the HFpEF (odds ratio, 3.28; 95% confidence interval, 1.55-6.96; P=0.002) but not in the heart failure with reduced ejection fraction cohort (odds ratio, 1.22; 95% confidence interval, 0.61-2.42; P=0.57). This association in the HFpEF cohort remained significant after adjusting for a history of hypertension and diabetes mellitus and the estimated glomerular filtration rate (odds ratio, 3.34; 95% confidence interval, 1.52-7.33; P=0.003). The use of intravenous diuretics was a significant predictor of PVR in the HFpEF and heart failure with reduced ejection fraction groups. Conclusions-The effect of estimated PVR differs by HF type, and the estimated PVR during hospitalization is a predictor of worsening renal function in patients with HFpEF but not in heart failure with reduced ejection fraction. Clinical Trial Registration

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Section: Discussionmentioning

confidence: 96%

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Takei

Kohsaka

Shiraishi

et al. 2015

Circ: Heart Failure

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show abstract

“…Whereas WRF was an independent risk factor for all analyzed outcomes, the effect size was larger in HFpEF; particularly for in‐hospital outcomes, effect size was 3‐fold larger in HFpEF. No current studies have compared the effect size of WRF in HF subtypes, whereas a previous study showed that WRF was a predictor of adverse events in HFpEF …”

Section: Discussionmentioning

confidence: 98%

Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry

Kang

Park

Cho

et al. 2018

JAHA

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BackgroundWorsening renal function (WRF) is associated with adverse outcomes in patients with heart failure. We investigated the predictors and prognostic value of WRF during admission, in patients with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF).Methods and ResultsA total of 5625 patients were enrolled in the KorAHF (Korean Acute Heart Failure) registry. WRF was defined as an absolute increase in creatinine of ≥0.3 mg/dL. Transient WRF was defined as recovery of creatinine at discharge, whereas persistent WRF was indicated by a nonrecovered creatinine level. HFpEF and HFrEF were defined as a left ventricle ejection fraction ≥50% and ≤40%, respectively. Among the total population, WRF occurred in 3101 patients (55.1%). By heart failure subgroup, WRF occurred more frequently in HFrEF (57.0% versus 51.3%; P<0.001 in HFrEF and HFpEF). Prevalence of WRF increased as creatinine clearance decreased in both heart failure subgroups. Among various predictors of WRF, chronic renal failure was the strongest predictor. WRF was an independent predictor of adverse in‐hospital outcomes (HFrEF: odds ratio; 2.75; 95% confidence interval, 1.50–5.02; P=0.001; HFpEF: odds ratio, 9.48; 95% confidence interval, 1.19–75.89; P=0.034) and 1‐year mortality (HFrEF: hazard ratio, 1.41; 95% confidence interval, 1.12–1.78; P=0.004 versus HFpEF: hazard ratio, 1.72; 95% confidence interval, 1.23–2.42; P=0.002). Transient WRF was a risk factor for 1‐year mortality, whereas persistent WRF had no additive risk compared to transient WRF.ConclusionsIn patients with acute heart failure patients, WRF is an independent predictor of adverse in‐hospital and follow‐up outcomes in both HFrEF and HFpEF, though with a different effect size.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01389843.

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“…If the decrease in GFR itself is the cause for the inferior outcomes, then in HFpEF where RAAS antagonism has no benefit, we would expect the risk of death associated with WRF to be identical in the placebo and RAAS antagonist groups. 21 To the contrary, the risk of death associated with RAAS antagonist-induced WRF was 53% greater than WRF in the placebo group. Notably, WRF in the placebo group was not actually significantly associated with worse outcomes (p=0.21).…”

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confidence: 94%

Worsening Renal Function and Mortality in Heart Failure

Testani

Brisco‐Bacik

2017

Circ: Heart Failure

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Worsening Renal Function and Outcome in Heart Failure Patients With Preserved Ejection Fraction and the Impact of Angiotensin Receptor Blocker Treatment

Abstract: The incidence of WRF in HFpEF was similar to that previously reported in HFrEF but more frequent with irbesartan than with placebo. WRF after initiation of irbesartan treatment in HFpEF was associated with excess risk, in contrast to WRF occurring with RAAS blockade in HFrEF.

Cited by 70 publications

References 23 publications

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry

Worsening Renal Function and Mortality in Heart Failure

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