Worsening renal function and all-cause mortality in patients with heart failure: an update of the literature

Abstract

Background: Despite the numerous evidence-based treatments for heart failure (HF), its prognosis has only shown moderate improvements in the past decades. Worsening renal function (WRF) is common among patients with HF, however, its impact on prognosis remains controversial. Some studies have shown that WRF is associated with unfavorable outcomes in HF populations including increased short- and long-term mortality. Conversely, others did not reveal a specific prognostic value of WRF suggesting that it is probably not related to increased mortality in some HF patients.

Objective: The objective of this review is to give an update of the literature from 2012 onwards on the relationship between WRF and mortality in patients with all types of HF to further clarify the prognostic significance of WRF on HF, which has not been established yet.

Method: We performed a literature search of the PubMed database for studies that investigated the relationship between WRF and mortality in HF patients. The literature search was limited to studies conducted between 2012 to 2022. Our primary focus was on studies that examined the association between WRF and mortality in HF patients (≥ 18 years old) with a confirmed diagnosis of HF in either the ‘acute or ‘chronic’ phase of the disease. Regarding WRF, we included only studies with a precise description of the WRF definition. The primary outcome measure was defined as all-cause mortality.

Results: Twelve studies were identified, six of which revealed WRF to be an independent predictor of all-cause mortality. However, there was inconsistency across the studies in terms of the definition of WRF, the timing of WRF occurrence, the type of HF patients, and the studied risk factors.

Conclusions: Taken together, there is still controversy regarding the prognostic impact of WRF on HF, and there is no gold standard to assess “true WRF.” Therefore, future studies are required to investigate the relationship between WRF and HF by using a more consistent definition in terms of the timing of WRF occurrence, as well as by including more homogeneous populations with respect to the risk factors.