Prognostic value of new-onset anemia as a marker of hemodilution in patients with acute decompensated heart failure and severe renal dysfunction

Background and purpose: In patients with acute decompensated heart failure (ADHF), the prognostic value of new-onset anemia with regard to renal function has not been investigated. Methods and subjects: Consecutive 299 ADHF patients (162 men, 62. ±. 14 years) were enrolled. Cardiovascular (CV) events composite of CV mortality and rehospitalization occurred in 113 patients (37.8%) during 2 years of follow-up. Results: Baseline anemia was prevalent (n=124, 41.5%) and 43 patients (14.4%) had new-onset anemia at 1 month after discharge. Baseline anemia was strongly associated with CV events risk in overall [hazard ratio (HR): 1.79, 95% CI: 1.17-2.74, p=0.006] and those with preserved renal function [estimated glomerular filtration rate (eGFR)≥45mL/min/1.73m²] (HR: 1.81, 95% CI: 1.05-3.12, p=0.031). In patients with severe renal dysfunction (eGFR<45mL/min/1.73m²), new-onset anemia independently predicted CV events (HR: 2.72, 95% CI: 1.09-6.76, p=0.031) whereas baseline anemia did not (HR: 1.28, 95% CI: 0.61-2.65, p=0.505). New-onset anemia was significantly associated with hemodilution, which may reflect inadequate decongestion in ADHF patients. Conclusions: Baseline anemia was an independent prognostic factor in overall ADHF patients and those with preserved renal function. New-onset anemia as a surrogate for hemodilution better predicted CV events than baseline anemia in ADHF patients with severe renal dysfunction.