Heart Failure and Worsening Renal Function: Prevalence, Risk Factors, and Impact on Hospital Readmissions in an Urban Minority Population

TL;DR

This study examines how often kidney function worsens in heart failure patients and finds that it is common, especially in older patients with diabetes and kidney disease.

Contribution

The study introduces a risk-scoring system to identify heart failure patients at high risk of worsening renal function.

Findings

Worsening renal function occurred in 27% of heart failure patients.

Older age, diabetes, and high-dose furosemide use were significant risk factors for worsening renal function.

A risk score of 6 or higher predicted a fourfold increased likelihood of worsening renal function.

Abstract

Background and Objectives: Heart failure (HF) often leads to worsening renal function (WRF), negatively impacting patient outcomes. This study aims to examine the incidence of WRF in HF patients, identify its risk factors, and assess its effect on readmissions. Materials and Methods: This retrospective analysis included 297 HF patients admitted to Harlem Hospital Center between January 2019 and December 2021. WRF incidence and its association with risk factors, hospital stays, and readmissions were analyzed. Data on age, type 2 diabetes, chronic kidney disease, high-dose furosemide use, and biomarkers (ProBNP, troponin T, creatinine) were collected. A risk-scoring system was developed to identify patients at higher risk for WRF. Results: WRF occurred in 27% of patients, with a significant correlation to longer hospital stays and lower cardiology follow-up adherence. Risk factors for WRF included older age, type 2 diabetes, chronic kidney disease, high-dose furosemide, and elevated ProBNP, troponin T, and creatinine levels. The risk scoring system revealed that patients scoring 6 or higher were four times more likely to develop WRF. Interestingly, WRF did not increase 30-day readmission rates. Conclusions: This study highlights the high incidence of WRF among HF patients, its impact on hospital stays and follow-up adherence, and the utility of a risk-scoring system to identify vulnerable patients. The findings offer valuable insights into improving care in minority-serving hospitals and provide a foundation for future research on WRF in HF patients.