Greetings! Thank you for your question and welcome to HCM. I understand your concern. A heart working only on 20% of its function is accompanied with a very poor prognosis. However, my opinion is that it would be speculative if I would give you an exact time frame of this prognosis. Kidney failure is probably a result of this low heart function, an insufficient heart which cannot fulfil end-organs needs and, as a compensatory mechanism, other organs fail, so that brain can be kept alive and supplied properly with blood. This heart pumps only 20% of its blood content during one systole, whereas a normal heart pumps 55-70% of it. The other problem is that this heart, besides pumping little amounts of blood to the periphery, it also is 80% filled with blood in the phase of cardiac cycle where pulmonary circulation is emptied into left heart chambers. This means high volume in pulmonary circulation - high pressures - pulmonary oedema, a life-threatening situation, imminent. To be frank, starting the inotropic agents (such as dopamine, dobutamine, adrenalin) in a heart failure patient is always a sign of poor prognosis. This means that this insufficient heart (pump) need extra drugs to pump even the 20% it can. At this point, it is recommended a careful monitoring and treatment with diuretics, besides other drugs in the therapy, and oxygen, and all these mandate hospitalization until, hopefully, steady and compensated state is reached. It is only then, when he can be discharged. I hope this was helpful and thorough. My regards, Dr. Meriton