Introduction: Haemodynamic changes in acute heart failure (AHF) are closely linked to renal function alterations. Pulse pressure (PP) may offer insights beyond mean arterial pressure in identifying patients with vulnerable renal function during AHF episodes. This study aimed to investigate the association between PP and renal function parameters, including urinary albumin-creatinine ratio (UACR) and changes in creatinine, in patients hospitalized for AHF. Methods: We conducted a retrospective observational study involving 695 patients admitted for AHF between June 2020 and April 2023. PP was calculated at admission, and renal function parameters were assessed over the first 48 h. A multivariable linear regression assessed the association between PP and UACR and creatinine changes, adjusting for possible confounders. Results: Patients in the highest tertile of PP exhibited a significantly higher incidence of worsening renal function (p = 0.048) and a lower incidence of improved renal function (p = 0.001). Multivariable analysis identified PP as an independent predictor of changes in creatinine (p = 0.010) and UACR (p = 0.037). The findings suggest that elevated PP may indicate impaired renal autoregulation and an increased risk of renal deterioration during AHF. Conclusion: In patients hospitalized for AHF, PP showed a positive and linear association with UACR values and changes in creatinine during the first 48 h of intravenous furosemide treatment. PP may help identify patients with kidneys more susceptible to haemodynamic changes during hospitalization for AHF.

As part of the “2nd Training Conference on Heart Failure and Atrial Fibrillation for Residents”, held in Madrid in November 2024, a collaborative initiative was launched to address the most common practical challenges in the management of heart failure (HF) in daily practice. This document is the result of the joint efforts of residents from various hospitals nationwide, in collaboration with senior physicians with extensive HF expertise and members of the Working Group of the Spanish Society of Internal Medicine. Our aim is to provide a useful tool that promotes learning and collaboration among professionals interested in this field. The structure of this document is based on a compilation of the most interesting and challenging questions raised during the conference. Each question is addressed with a concise and practical response, supported by updated references to ensure scientific rigor and facilitate consultation.

As part of the “2nd Training Conference on Heart Failure and Atrial Fibrillation for Residents”, held in Madrid in November 2024, a collaborative initiative was launched to address the most common practical challenges in the management of heart failure (HF) in daily practice. This document is the result of the joint efforts of residents from various hospitals nationwide, in collaboration with senior physicians with extensive HF expertise and members of the Working Group of the Spanish Society of Internal Medicine. Our aim is to provide a useful tool that promotes learning and collaboration among professionals interested in this field. The structure of this document is based on a compilation of the most interesting and challenging questions raised during the conference. Each question is addressed with a concise and practical response, supported by updated references to ensure scientific rigor and facilitate consultation.