Predictors of Worsening Renal Function in Patients Hospitalized with Acute Heart Failure

Open Access

Abstract

Background: Worsening renal function (WRF) is a frequent and clinically important complication among patients hospitalized with acute heart failure (AHF), leading to increased morbidity, prolonged hospitalization, and poor clinical outcomes. Early identification of patients at high risk of WRF may facilitate timely intervention and improve prognosis. Aim of the study: To identify the predictors of worsening renal function in patients hospitalized with acute heart failure and evaluate its association with in-hospital clinical outcomes. Methods & Materials: This prospective observational study was conducted in the Departments of Nephrology and Cardiology at Bangladesh Medical University, Dhaka, Bangladesh, from June 2023 to March 2025. A total of 58 adult patients admitted with acute heart failure and baseline serum creatinine <1.3 mg/dL were enrolled. Worsening renal function was defined as an increase in serum creatinine of ≥0.3 mg/dL within 48 hours or ≥1.5 times the baseline value within seven days. Demographic, clinical, laboratory, echocardiographic, and biomarker data, including urinary TIMP-2×IGFBP-7, were collected. Independent predictors of WRF were identified using multivariable logistic regression analysis. Result: Worsening renal function developed in 23 (39.7%) patients. Patients with WRF more frequently had diabetes mellitus (60.9% vs. 31.4%, p=0.027), previous heart failure admission (65.2% vs. 37.1%, p=0.034), NYHA class IV symptoms (69.6% vs. 51.4%, p=0.048), lower estimated glomerular filtration rate, lower serum albumin, higher inflammatory markers, elevated NT-proBNP, and markedly increased urinary TIMP-2×IGFBP-7 levels (all p<0.05). Hospital stay was significantly longer (9.2±3.1 vs. 6.4±2.3 days, p<0.001), and ICU admission was more frequent among patients with WRF (43.5% vs. 17.1%, p=0.030). Multivariable logistic regression identified diabetes mellitus (adjusted OR=2.74, p=0.048), previous heart failure admission (adjusted OR=2.96, p=0.044), serum albumin <3.5 g/dL (adjusted OR=3.41, p=0.046), eGFR <70 mL/min (adjusted OR=3.84, p=0.026), NT-proBNP >5000 pg/mL (adjusted OR=3.67, p=0.032), and urinary TIMP-2×IGFBP-7 >0.312 (adjusted OR=13.94, p<0.001) as independent predictors of WRF. Conclusion: Worsening renal function occurred in nearly two-fifths of hospitalized patients with acute heart failure and was associated with adverse in-hospital outcomes. Diabetes mellitus, previous heart failure admission, impaired renal function, hypoalbuminemia, elevated NT-proBNP, and particularly increased urinary TIMP-2×IGFBP-7 independently predicted WRF. Early risk stratification using these clinical and biomarker-based predictors may improve patient monitoring and optimize management strategies.