Comparison of risk factors for acute worsening renal function in heart failure patients with and without preserved ejection fraction

Objective: We compared the risk factors for acute worsening renal function (AWRF) in patients with acute decompensated heart failure with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF). Methods: We retrospectively studied 181 consecutive patients. AWRF was defined as a rise in serum creatinine of >= 0.3 mg/dL from admission to day 3. Potential risk factors of AWRF were identified in univariate analyses; then logistic regression analysis with backward stepwise selection was performed. Results: In the present study of limited sample size, 46% had HFpEF (EF >= 50%) and 54% had HFrEF (EF < 50%). In the HFpEF group, history of hypertension (odds ratio [OR] 32.46,95% CI 239-440.12, P = 0.009), the increased serum potassium value at admission (OR 4.61, 95% CI 1.14-18.73,P = 0.032), and the pretreatment with calcium channel blocker (OR 8.52, 95% CI 1 21-60.09, P = 0.032) were independent risk factors (defined as P <0.05 and OR> 1.01) for AWRF. In contrast, diastolic blood pressure at admission (OR 1.07,95% CI 1.02-1.13, P= 0.004) was the sole independent risk factor for AWRF in the HFrEF group. Conclusions: Hypertension was associated with AWRF in both HFpEF and HFrEF patients. A history of hypertension was more important than elevated blood pressure at admission as a risk factor for AWRF in HFpEF, whereas the reverse was observed for HFrEF. Among antihypertensive drugs, pretreatment with calcium channel blocker was an independent risk factor for AWRF in HFpEF, but not in HFrEF. (C) 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.