Worsening Renal Function in Acute Heart Failure: Not Always Harmful.

IF 3.4 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Heart Failure Reports Pub Date : 2025-09-26 DOI:10.1007/s11897-025-00714-z

Yukihiro Watanabe, Yoshiaki Kubota, Kuniya Asai

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Abstract

Purpose of review: Worsening renal function (WRF) frequently occurs in acute heart failure (AHF) and represents a clinical challenge, as it may lead to inappropriate alterations in therapy. Understanding its mechanisms and prognostic implications is essential for optimization of treatment.

Recent findings: The prognostic impact of WRF depends on clinical context. WRF is associated with poor outcomes when residual congestion persists; however, it is not harmful if effective decongestion is achieved. Systemic processes such as inflammation and oxidative stress may contribute to WRF with adverse outcomes, as demonstrated by novel biomarkers. Conversely, the initial decline in glomerular filtration rate observed following the initiation of heart failure therapies is typically a benign physiological response. This review outlines the concept, pathophysiology, prognosis, and management of WRF in AHF. Clinicians should carefully interpret the clinical context of WRF and avoid the premature discontinuation of heart failure therapies to ensure optimal therapeutic decision-making.

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急性心力衰竭时肾功能恶化：并不总是有害的。

回顾目的：肾功能恶化（WRF）经常发生在急性心力衰竭（AHF）中，这是一个临床挑战，因为它可能导致治疗的不适当改变。了解其机制和预后意义对于优化治疗至关重要。近期研究发现：WRF对预后的影响取决于临床情况。当剩余拥塞持续存在时，WRF与不良结果相关；然而，如果能有效地缓解充血，这是无害的。新的生物标志物表明，炎症和氧化应激等系统过程可能导致WRF的不良后果。相反，在心力衰竭治疗开始后观察到的肾小球滤过率的最初下降通常是良性的生理反应。本文综述了AHF中WRF的概念、病理生理、预后和治疗。临床医生应仔细解释WRF的临床背景，避免过早停止心力衰竭治疗，以确保最佳的治疗决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Heart Failure Reports Medicine-Emergency Medicine

CiteScore

5.30

自引率

0.00%

发文量

期刊介绍： This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of heart failure. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as investigative, pharmacologic, and nonpharmacologic therapies, pathophysiology, and prevention. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.