Recovery of worsening renal function after acute heart failure
In brief
Kidney recovery after acute heart failure linked to 77% lower mortality
Among 331 patients whose kidney function worsened during a heart-failure hospitalization, 54% had recovered by 12 months. Those who recovered had about 77% lower adjusted mortality over the following five years than those with persistent kidney problems. This observational association does not prove recovery caused better survival, but it underscores the importance of following kidney function after discharge.
- Journal
- European journal of internal medicine (Q1)
- Published
- 28 October 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Daniele Cocianni, Stefano Contessi, Maria Perotto, Davide Barbisan, Jacopo Giulio Rizzi, Giulio Savonitto, et al.
- PMID
- 42951732
- DOI
- 10.1016/j.ejim.2026.107246
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 1 November 2026): Heart failure admission, renal recovery, and long-term prognosis
Abstract
BACKGROUND: Worsening renal function (WRF) is common during hospitalization for acute decompensated heart failure (ADHF). However, the post-discharge trajectory of renal function in these patients remains unclear. We aimed to evaluate the rate of WRF recovery after discharge and its prognostic significance. METHODS: In a cohort of 2020 patients hospitalized for ADHF (TRI-AHF registry), serum creatinine was measured at admission, daily during hospitalization, and at 12 months after discharge. WRF was defined as a creatinine increase ≥0.3 mg/dL. Only patients who developed WRF during the index hospitalization were included. At the 12-month follow-up, WRF was classified as recovered if the change in creatinine from admission was <0.3 mg/dL, and persistent if ≥0.3 mg/dL. The primary endpoint was 5-year all-cause mortality after the 12-month creatinine reassessment. RESULTS: During the study period, 331 patients (16%) experienced WRF. At 12 months, 157 (54%) had recovered WRF and 133 (46%) had persistent WRF. Older age, elevated natriuretic peptide levels, and right ventricular dysfunction during hospitalization were independent predictors of persistent WRF. At 5-year follow-up after the 12-month assessment, recovered WRF was strongly associated with a lower risk of mortality compared with persistent WRF (adjusted HR=0.229, p < 0.001). The association between WRF recovery and improved survival was independent of prior chronic kidney disease and baseline creatinine, and appeared more pronounced in males than in females (p-int=0.034). CONCLUSIONS: Among patients hospitalized for ADHF who experienced WRF, 54% recovered renal function at 12 months. Recovery of WRF was associated with significantly better long-term survival compared with persistent WRF.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.