Decongestion discriminates risk for one‐year mortality in patients with improving renal function in acute heart failure

Aims Improving renal function (IRF) is paradoxically associated with worse outcomes in acute heart failure (AHF), but may differ based on response to decongestion. We explored if the relationship of IRF mortality hospitalized AHF patients differs successful Methods and results evaluated 760 from AKINESIS for between IRF, change B-type natriuretic peptide (BNP), 1-year mortality. was defined as a ≥20% increase estimated glomerular filtration rate (eGFR) relative admission. Adequate decongestion ≥40% decrease last measured BNP occurred 22% who had mean age 69 years, 58% were men, 72% white, median admission eGFR 49 mL/min/1.73 m2. more severe reflected by lower eGFR, higher blood urea nitrogen, systolic pressure, sodium, use inotropes. (25%) than non-IRF (15%) (P < 0.01). However, this differed trajectory (P-interaction = 0.03). When stratified change, decreasing either without BNP. multivariate analysis, not [adjusted hazard ratio (HR) 1.0, 95% confidence interval (CI) 0.7–1.5] while (adjusted HR 0.5, CI 0.3–0.7). transiently occurring or persisting at discharge, again only significantly Conclusion independent other variables congestion status. Achieving adequate decongestion, BNP, strongly IRF.