Abstract 13504: Potential Etiologies and Prognostic Implications of Acute Kidney Injury in Acute Decompensated Heart Failure
Introduction: One third of patients hospitalized for acute heart failure (AHF) develop acute kidney injury (AKI) associated with increased in-hospital morbidity and mortality. However, previous investigations have not evaluated the various etiologies of AKI and their impact on prognosis.
Methods: Medical records of patients admitted with AHF between 2008 and 2010 who had a rise of serum creatinine ≥ 0.3mg/dl on admission or during their hospital stay were reviewed for the etiology of AKI. Exclusion criteria were chronic dialysis, shock on admission, or exposure to nephrotoxic drugs before admission. Diuresis-induced AKI included cases with AKI following ≥ 2 days of diuresis which improved with fluid resuscitation or holding of diuretics, or who had objective evidence of hypovoelmia. Cardiorenal syndrome type 1 (CRS1) was defined as absence of another explanation for AKI plus either improvement of kidney function with diuresis or diuretic resistance with persistent signs of AHF.
Results: ICD codes identified 1821 hospital admissions with AHF, 319 of which (20%) were complicated with AKI. The most common causes of AKI were CRS1 (43.1%) and diuresis-induced hypovolemia (42.8%) (Table 1 ). Other causes (14.1%) included nephrotoxins (5.9%), surgery (3.7%). The mortality rate was significantly lower with over diuresis compared to CRS1; Odds ratio 0.059 (95% CI 0.007 to 0.45, P = 0.006). Predictors of mortality in CRS1 are listed in Table 2 . Readmission at 30 days was higher in cases with CRS1 (42%) (Table 1 ).
Conclusions: AKI with AHF is a heterogeneous group, and most common etiologies are CRS1 and diuresis-induced hypovolemia. CRS1 had a higher in-hospital mortality and readmission rates.
- © 2013 by American Heart Association, Inc.