Analysis Of Risk Factors Associated With The Development Of Deteriorating Renal Function In Patients With Chronic Heart Failure

Background:Epidemiological data show that the global prevalence of heart failure(heart failure)in adults is 1-3%,and there are approximately 4 million cases of heart failure in China.In patients with chronic heart failure(CHF),an increase in central venous pressure(CVP)leads to a decrease in glomerular capillary blood flow and increases interstitial and tubular pressure in the kidney.Patients with renal insufficiency have a worse prognosis.Therefore,the protective management of the kidney and attention to changes in renal function in patients with heart failure are particularly important in the management of heart failure diagnosis and treatment.Objective:In this study,we collected clinical data from patients with CHF and analyzed the occurrence of deterioration of renal function(WRF)during hospitalization in patients with chronic heart failure,as well as the risk factors affecting the deterioration of renal function,so as to achieve early prevention and intervention of renal function deterioration in patients with CHF.Methods:Patients with heart failure hospitalized in the Department of Cardiovascular Medicine of the First Hospital of Guangzhou Medical University from January 2020 to November 2022 were retrospectively collected,and the diagnosis of heart failure was referred to the 2022 ACC/AHA/HFSA Heart Failure Guidelines,and 358 patients with chronic heart failure were finally included in this study.Blood creatinine indices were collected from patients on admission and at discharge.Creatinine clearance was calculated using the Chinese MDRD formula(c-MDRD): e GFR [ml/(min-1.73m2)] =170 x [serum creatinine(mg/dl)]-1.234 x(age)-0.179 x(1 male;0.79 female).The group with normal renal function on admission was defined as e GFR ≥ 60(ml/(min-1.73m2))and the group with renal insufficiency on admission was defined as e GFR <60(ml/(min-1.73m2)).The difference in blood creatinine between admission and discharge of patients was calculated: ΔScr = highest Scr during hospitalisation-Scr at admission.deterioration in renal function during hospitalization was defined as ΔScr≥ 26.5 μmol/L.The study population was divided into two groups: the group with no deterioration in renal function(group A)and the group with deterioration in renal function(group B).Data were collected on age,gender,past history,smoking history,alcohol history,laboratory findings such as hemoglobin,imaging findings,clinical diagnosis,and management of treatment.Statistical analyses were performed using SPSS 27.0software with test level: two-sided α=0.05.Measures were subject to separate tests of normality(Kolmogorov-Smirnov test),and normally distributed measures were statistically described using mean ± standard deviation(X±s)and t-test for comparison between groups;those that did not obey normal distribution The median M(P25,P75)was used for the statistical description of the measures that did not follow a normal distribution,and the Mann-Whitney U test was used for comparison between groups.Count data were expressed as rates,percentages,and the chi-square test(χ2 test)were used to represent comparisons between groups.We compared the clinical data of the two groups to analyze their clinical characteristics and to analyze the risk factors influencing the deterioration of renal function during hospitalization.Single-factor logistic regression was used to analyze the risk factors affecting the deterioration of renal function,and then multi-factor logistic regression was used to explore the risk factors for the deterioration of renal function in hospitalized heart failure patients.Results:(1)A total of 358 patients with chronic heart failure were included,of whom 175(48.9%)were in the group with normal renal function on admission and 183(51.1%)were in the group with renal insufficiency on admission.The group admitted with renal insufficiency was older,had a higher proportion of smoking,more combined hypertension and coronary artery disease,higher glycated hemoglobin,blood uric acid,NT-pro BNP and blood potassium,lower hemoglobin,and a higher proportion of taking CCB and lipid-lowering drugs.(2)Of the 358 patients with chronic heart failure,271(75.7%)were in the group with no deterioration in renal function(Group A)and 87(24.3%)were in the group with deterioration in renal function(Group B).The group with deteriorating renal function was older,more often combined with renal insufficiency,diabetes mellitus,and atrial fibrillation on admission,had lower hemoglobin,higher potassium,uric acid,and NT-pro BNP,and had higher rates of contrast and anticoagulant use and lower use of sodium-glucose co-transport protein 2 inhibitors during hospitalization.One-way logistic regression analysis showed that age,history of hypertension,history of atrial fibrillation,renal insufficiency on admission,NT-pro BNP values,use of anticoagulant drugs,and use of SGLT2 i drugs were influential factors affecting deterioration in renal function.Multi-factor logistic regression analysis suggested that advanced age,history of atrial fibrillation,concomitant renal insufficiency on admission,and non-use of SGLT2 i medication were independent risk factors for deterioration of in-hospital renal function.Conclusions:(1)Patients with chronic heart failure have a high prevalence of concomitant renal insufficiency.(2)Advanced age,history of atrial fibrillation,admission with renal insufficiency,and non-use of SGLT2 i drugs are independent risk factors for deterioration of renal function during hospitalization in patients with chronic heart failure.