Worsening Renal Function and Outcomes in Heart Failure Patients With Reduced Ejection Fraction

R. Ravikulan, J. Gunton, J. Harris, Y. Sharma, S. Sumandasa, R. Lek, M. Le, A. Hussein, C. De Pasquale

Research output: Contribution to journalMeeting Abstractpeer-review



While modern therapy has improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF) there is often conflict between therapy and renal function. The resulting variability in management strategies may adversely affect patient care. We explored the relationship between renal function and outcomes in acute decompensated (AD) HFrEF (EF<40%).

Flinders Medical Centre inpatients with a primary diagnosis of AD HFrEF were studied. Data is presented as median (25th, 75th percentile), statistical analysis by Mann-Whitney U and Chi-square test, p value <0.05 reported.

One hundred and thirteen AD HFrEF patients aged 76 years (65, 87) with EF 28% (22, 35), creatinine 106mmol/L (85, 158) and urea 9 (6, 13) were recruited. Length of stay was 5 days (3, 9) with weight loss of 2.4kg (0.3, 3.9). During admission, creatinine increased 20% (5, 33) and urea 19% (-9.5, 38). After 2.5 years, 56 patients (50%) had either CV re-admission (45%) and/or death (36%). CKD was significantly associated (p<0.001) with death but not CV re-admission. Deterioration in creatinine and urea during admission were not significantly associated with death or CV readmissions. Indeed, while a decrease in eGFR of 30% during hospitalisation trended towards events (p=0.09); urea increase of 100% or creatinine increase of >50% still had no signal of association with events post-discharge (both p=0.9).

Whereas poor baseline renal function is strongly associated with mortality, a deterioration of renal function during admission was not associated with death and/or CV readmission, giving clinical priority to aggressive decongestion in AD HFrEF.
Original languageEnglish
Pages (from-to)S143-S144
Number of pages2
JournalHeart, Lung and Circulation
Issue numberSupp. 3
Publication statusPublished - 1 Jan 2021
Externally publishedYes


  • Heart Failure With Reduced Ejection Fraction
  • HFrEF
  • Renal function


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