Abstract 13623: Moderate to Severe Acute Kidney Injury During Heart Failure Treatment is a Long-Term Predictor of Sudden Cardiac Death in Patients Discharged From Acute Heart Failure
Backgroud: Acute kidney injury (AKI) during heart failure treatment is associated with early poor outcome in patients hospitalized for acute heart failure (AHF). Prediction of mode of death (sudden cardiac death (SCD) or pump failure death(PFD)) after the discharge may facilitate decisions about specific medications or devices. However, there is no information available on the long-term prognostic significance of AKI, from the viewpoint of mode of death.
Methods and Results: We studied 287 consecutive patients hospitalized for AHF and discharged with survival. AKI during AHF treatment was defined according to AKI Network criteria (stage 1, ≥0.3mg/dl absolute or 1.5- to 2.0-fold relative increase in serum creatinine (s-Cr); stage 2, >2- to 3-fold increase in s-Cr; stage 3, >3-fold increase in s-Cr or s-Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). Patients with stage 1 (n=131) and stage 2 or 3 (n=42) AKI were significantly older and had lower eGFR than those without AKI (n=114), while there were no significant differences in the other baseline clinical characteristics including LVEF among the three groups. During a mean follow-up period of 4.4±3.3 (0-13) yrs, 23 patients had SCD and 18 patients had PFD. The adjusted hazard ratio (HR) for SCD was 5.25 (95%CI 1.60 to 17.20, p=0.0061) with stage 2 or 3 AKI compared with no AKI, while the adjusted HR for SCD was insignificant in patients with stage 1 AKI (1.64 (95%CI, 0.56 to 4.80, p=0.37)). On the other hand, the adjusted risk for PFD was insignificant; 1.45 (95%CI, 0.49 to 4.30, p=0.50) with stage 1 AKI and 2.03 (95%CI 0.53 to 7.83, p=0.30) with stage 2 or 3 AKI.
Conclusions: Moderate to severe (stage 2 or 3) AKI during AHF treatment would have long-term prognostic significance for SCD but not for PFD after the discharge.
- © 2011 by American Heart Association, Inc.