Factors contributing to transient and persistent worsening renal function in elderly patients with acute decompensated heart failure.

BACKGROUND

The aim of this study is to analyze the distinct characteristics and risk factors contributing to the development of worsening renal function (WRF) in elderly patients with acute decompensated heart failure (ADHF), while also examining the subset of persistent WRF among elderly patients with ADHF.

METHODS

In this retrospective study, patients were stratified into two groups, non-WRF and WRF, based on alterations in creatinine levels. Subsequently, the WRF group was further delineated into transient and persistent WRF subgroups, contingent upon temporal changes in creatinine levels. There 218 elderly ADHF patients aged ≥ 60 years old, with an average age of (72.11 ± 7.94) years old. Among them, 66 patients with ADHF developed WRF during hospitalization, with an incidence of 30.28%. Among the 66 WRF patients, 20 cases were transient WRF and 46 cases were persistent WRF. The study revealed notable distinctions within the WRF cohort, characterized by heightened smoking prevalence, significantly elevated brain natriuretic peptide (BNP) levels at admission, diminished hematocrit (HCT) levels and more applications. ACEI (angiotensin-converting enzyme inhibitors) or ARB (angiotensin receptor inhibitor) or ARNI (angiotensin receptor neprilysin inhibitor) drugs. Within the persistent WRF subgroup, patients were characterized by advanced age, predominantly male gender distribution, heightened incidence of coronary artery disease, and significantly elevated systolic blood pressure (SBP), uric acid, BNP, and glycosylated hemoglobin levels compared to their transient WRF counterparts, while displaying lower D-dimer levels. In multivariate analysis, BNP level (OR = 1.001, 95%CI 1.000-1.001;  = 0.032), D-dimer level (OR = 1.013, 95%CI 1.003–1.024;  = 0.013), ACEI or ARB or ARNI drugs (OR = 19.656, 95%CI 8.698–30.763;  = 0.009) were positively correlated with the occurrence of WRF. HCT level was negatively correlated with the occurrence of WRF (OR = 0.850, 95%CI 0.744–0.970;  = 0.016). Systolic blood pressure (OR = 1.158, 95%CI 1.051–1.276;  = 0.003), D-dimer levels (OR = 0.998, 95%CI 0.997–0.999;  < 0.001) were associated with persistent WRF.

CONCLUSION

The findings of this study indicate a clear association between BNP, HCT, D-dimer levels and ACEI or ARB or ARNI drugs and the emergence of WRF in elderly individuals with ADHF. Furthermore, the study underscores that persistent WRF is notably linked with systolic blood pressure and D-dimer levels.