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Worsening renal function during hospitalization in elderly patients with heart failure: an independent factor of activities of daily living decline

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Abstract

This study aimed to clarify the effects of worsening renal function (WRF) during hospitalization on activities of daily living (ADL) at discharge of elderly heart failure (HF) patients. We included 323 consecutive patients hospitalized for HF who were prescribed phase I cardiac rehabilitation (CR) from November 2017 to April 2019. WRF was defined as a relative increase from baseline in serum creatinine of 25% or that in serum creatinine ≥ 0.3 mg/dL during hospitalization. The indices of ADL and physical function were the functional independence measure (FIM), short physical performance battery (SPPB) and 10-m comfortable gait speed as assessed at discharge. We compared background factors, clinical parameters, walking level before hospitalization, physical function, and FIM in two groups. Multiple regression analysis was performed with FIM at discharge as the dependent variable and items with P < 0.05 in bivariate correlation as independent variables. Ultimately, 160 patients were included and divided into the WRF group (n = 72) and non-WRF group (n = 88). FIM, SPPB, and 10-m comfortable walking speed were significantly lower in the WRF group. Moreover, even after adjustment for confounding factors (age, Hb, eGFR, CKD, GNRI, start day of standing), eGFR on admission (β = 0.12), WRF (β =  − 6.42) and walking level before hospitalization (β = − 10.00) were independent factors of ADL decline at discharge (adjusted R2 = 0.46). WRF during hospitalization of elderly HF patients was a factor affecting ADL decline at discharge along with walking level before hospitalization and renal function at admission.

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Abbreviations

ADL:

Activities of daily living

BMI:

Body mass index

CKD:

Chronic kidney disease

CR:

Cardiac rehabilitation

eGFR:

Estimated glomerular filtration rate

FIM:

Functional Independence Measure

GNRI:

Geriatric Nutrition Risk Index

HF:

Heart failure

LVEF:

Left ventricular ejection fraction

SPPB:

Short performance physical battery

WRF:

Worsening renal function

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Acknowledgements

The authors would like to thank all of the participating patients in Yodogawa Christian Hospital.

Funding

This work was funded by a JSPS KAKENHI grant (no. JP17K01500).

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Authors and Affiliations

  1. Department of Rehabilitation, Yodogawa Christian Hospital, Osaka, Japan

    Ikko Kubo, Nozomu Kajisa, Masanobu Ryu & Hideki Akasaka

  2. Department of Public Health, Kobe University Graduate School of Health Sciences, 10-2 Tomogaoka 7-chome, Suma, Kobe, 654-0142, Japan

    Ikko Kubo, Kazuhiro P. Izawa, Asami Ogura & Masashi Kanai

  3. Cardiovascular stroke Renal Project (CRP), Kobe, 654-0142, Japan

    Ikko Kubo, Kazuhiro P. Izawa, Asami Ogura & Masashi Kanai

  4. Department of Cardiovascular Medicine, Yodogawa Christian Hospital, Osaka, Japan

    Hiroki Matsuzoe & Daisuke Matsumoto

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  1. Ikko Kubo
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Contributions

Conceptualization: IK and KPI; formal analysis: IK; investigation: IK, NK, MR, and HA; data curation: IK; writing—original draft preparation: IK, AO, and MK; writing—review and editing: KPI, HM, and DM; supervision: KPI and HM; project administration: KPI and DM; funding acquisition: KPI. All authors approved the manuscript for submission.

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Correspondence to Kazuhiro P. Izawa.

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Kubo, I., Izawa, K.P., Kajisa, N. et al. Worsening renal function during hospitalization in elderly patients with heart failure: an independent factor of activities of daily living decline. Heart Vessels 36, 76–84 (2021). https://doi.org/10.1007/s00380-020-01672-3

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