Background: Renal dysfunction (RD) is a predictor of poor prognosis in patients with acute decompensated heart failure (ADHF). However, little is known its impact of long-term prognosis and the subgroups related to a higher risk of poor prognosis. Methods: We retrospectively analyzed 1072 consecutive patients hospitalized for ADHF and divided them into two groups based on the level of estimated glomerular filtration rate; 578 patients with eGFR < 45 ml/min/1.73 m2 as RD group and 593 patients with eGFR ≧ 45 ml/min/1.73 m2 as non-RD group. We compared all-cause death between the two groups. Subgroup analysis in RD group was performed to further stratify the risk of all-cause death. Results: The 180-day cumulative survival rate was significantly higher in the RD group than in the non-RD group (15.9% vs. 9.2%, P < .01). Multivariate Cox proportional hazards model showed that over 80 years old age (hazard ratio[HR], 1.66; 95% confidence interval [CI], 1.08 to 2.56; P = .02), hyponatremia (<135 mEq/L) (HR, 1.71; 95% CI, 1.08 to 2.71; P = .02), and prior ischemic heart disease (HR, 1.53; 95% CI, 1.02 to 2.29; P = .04) were independent predictors of all-cause death. Conclusion: Renal dysfunction is strongly associated with worse prognosis in ADHF patients. Elderly age and hyponatremia, and a history of ischemic heart disease were negative predictors of all-cause death in ADHF patients with renal dysfunction.
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