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The present study investigated whether on-admission aortic pulsatile hemodynamics is associated with IRF and in-hospital changes in renal function, and modulates its impact on postdischarge adverse events in patients with AHF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A total of 240 AHF patients (69.3\u2005\u00b1\u200515.6 years, 76.7% men) were enrolled and followed for outcomes of heart failure hospitalization and death up to 3 years after discharge. Measures of renal function and aortic pulsatile hemodynamics, including carotid-femoral pulse wave velocity (cf-PWV) and the amplitude of the reflected wave (Pb), were obtained within 24 h of admission and before discharge. IRF was defined by an estimated glomerular filtration rate (eGFR)\u2005&amp;lt;\u200560 ml\/min\/1.73 m\u00b2<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>On admission, 159 patients (66.3%) presented with IRF. At discharge, eGFR significantly improved by 6.6\u2005\u00b1\u200513.4 ml\/min\/1.73m\u00b2 (19.3\u2005\u00b1\u200544.7%, P\u2005&amp;lt;\u20050.001) in patients with on-admission IRF. Increased on-admission aortic pulsatile hemodynamics was significantly associated with the presence of IRF and inversely associated with the in-hospital improvement of eGFR. Persistent IRF on both admission and discharge (hazard ratio 1.579, 95% CI 1.078\u20132.315), change of eGFR per 1 standard deviation increment (0.747, 0.597\u20130.934), and over 30% improvement of eGFR (0.492, 0.306\u20130.792) were significantly predictive of postdischarge events in multivariable Cox models incorporating either cf-PWV or Pb.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>On-admission aortic pulsatile hemodynamics was significantly associated with IRF and in-hospital changes in renal function in patients with AHF, and both were significantly associated with postdischarge adverse events independent of aortic pulsatile hemodynamics.<\/jats:p>\n               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