Abstract Background: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF). Methods and results: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a ≥25% and a ≥0.3 mg/dL increase in serum creatinine (s‐Cr) from admission (WRF‐Abs‐%). Results: Patients were followed for 480±363 days. Fifty‐three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF‐Abs‐% occurred in 107 (34%) patients. At multivariable survival analysis, WRF‐Abs‐% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13–1.81; p =0.024). The independent predictors of WRF‐Abs‐%, evaluated using multivariable logistic regression, were history of chronic kidney disease ( p =0.002), LV ejection fraction ( p =0.012), furosemide daily dose ( p =0.03) and NYHA class ( p =0.05) on admission. Conclusion: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance