WORSENING RENAL FUNCTION IN ACUTE DECOMPENSATED HEART FAILURE: A BAD SIGN, OR MAYBE NOT?

Introduction: Prognostic role of worsening renal function (WRF) during hospitalization for acute decompensated heart failure remains controversial. Methods: We reviewed the medical literature on the association of WRF during acute decompensated heart failure with clinical outcomes. Results: WRF is reported in approximately 25% to 40% of acute decompensated heart failure patients. WRF is usually, but not always associated with worse outcomes in patients with heart failure. Transient WRF accompanied with hemoconcentration, effective decongestion strategies, and initiation of appropriate medical treatment for heart failure with angiotensin-converting enzyme inhibitors or mineralocorticoid receptor antagonists is not associated with worse outcomes. Conclusions: Multiple mechanisms may contribute to WRF in acute decompensated heart failure, and prognosis will differ according to etiology, patient features, and treatment strategies. During hospitalization, treatment should focus on the patient's clinical status, resolution of symptoms and signs of congestion rather than temporary changes in renal function.