WRF During Decongestion — EECC MCQ

Correct answer: D — Worsening renal function during decongestion may reflect transient haemodynamic changes and does not always mandate stopping diuretics; if the patient remains congested, decongestion should continue with close monitoring — persistent congestion is a stronger predictor of poor outcomes than transient creatinine rise

The relationship between diuresis and renal function in acute HF is nuanced. Worsening renal function (WRF) during decongestion can be: (1) 'pseudo-WRF' — creatinine rises due to haemoconcentration and reduced renal venous congestion (actually a good sign of effective decongestion), associated with BETTER outcomes if the patient is being effectively decongested; (2) true cardiorenal syndrome — renal hypoperfusion from excessive volume depletion. Persistent congestion at discharge is a stronger predictor of readmission and mortality than transient WRF during decongestion. The ESC HF Guidelines recommend monitoring renal function but continuing decongestion if the patient remains congested, adjusting diuretic doses based on clinical response and urine output rather than creatinine alone.

Reference: ESC (2023): HF Guidelines