Worsening renal function is not associated with response to treatment in acute heart failure

Background: About a fourth of acute decompensated heart failure (ADHF) patients develop renal dysfunction during their admission. To date, the association of ADHF treatment with the development of worsening renal function (WRF) remains contentious. Thus, we examined the association of WRF with changes in BNP levels and with mortality. Methods: We performed retrospective chart review of patients admitted with ADHF who had BNP, eGFR, creatinine and blood urea nitrogen (BUN) values measured both on admission and discharge. Survival analysis was conducted using Cox proportional hazards model and correlation was measured using Spearman's rank correlation test. Results: 358 patients admitted for ADHF were evaluated. WRF was defined as >20% reduction in eGFR from admission to discharge and response to treatment was assessed by Delta BNP. There was a statistically significant reduction in BNP and increase in BUN during the admission. Delta BNP did not correlate with either Delta GFR or Delta BUN. Patients who developed WRF and those who did not, had a similar reduction in BNP. On univariate survival analysis, Delta BUN, but not Delta eGFR, was associated with 1-year mortality. In multivariate Cox proportional hazards model, BUN at discharge was associated with 1-year mortality (HR: 1.02, p<0.001), but Delta eGFR and Delta BUN were not associated with the primary endpoint. Conclusion: During ADHF treatment, Delta BNP was not associated with changes in renal function. Development of WRF during ADHF treatment was not associated with mortality. Our study suggests that development of WRF should not preclude diuresis in ADHF patients in the absence of volume depletion. (C) 2012 Published by Elsevier Ireland Ltd.