Abstract 14841: Progressive Hyponatremia During Heart Failure Treatment Provides Additional Long-Term Prognostic Information to Acute Kidney Injury in Patients Admitted With Acute Decompensated Heart Failure
Backgrounds: Acute kidney injury (AKI) during heart failure treatment is associated with poor outcome in patients (pts) admitted with acute decompensated heart failure (ADHF). Hyponatremia and hypoalbuminemia have been shown to be also associated with mortality in ADHF pts. However, there is no information available on the long-term prognostic significance of the progression of these parameters during hospitalization in pts with survival discharge from ADHF, relating to AKI.
Methods and Results: We studied 305 consecutive pts admitted with ADHF and discharged with survival. The measurements of serum sodium (Na), albumin (Alb) and creatinine (s-Cr) levels were repeated during the treatment of congestion, and the depression of serum sodium and albumin in comparison to the value at admission were obtained. AKI during ADHF treatment was defined according to AKI Network criteria (stage 1, ≥0.3mg/dl absolute or 1.5- to 2.0-fold relative increase in 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). During a follow-up period of 4.4±3.3 yrs, 72 pts had cardiovascular death (CVD). At multivariate Cox analysis, Na depression after the admission (p<0.0001) and AKI (p=0.0037) were significantly associated with CVD independently of Na at admission and Alb at discharge, although the Alb depression showed the association with CVD at univariate analysis. Pts with progressive hyponatremia, which was defined as higher degree of Na depression after the admission (≥8mEq/L: the lowest quartile value) had a significantly higher risk of CVD in each stage (stage 2/3: 82% vs 21%, p=0.0003, adjusted hazard ratio (HR): 13.4 (1.7-106.0); stage 1: 41% vs 15%, p=0.0016, HR: 2.5 (1.1-6.0); no AKI: 62% vs 14%, p=0.0016 HR: 3.4 ( 1.6-7.3)).
Conclusion: Progressive hyponatremia during heart failure treatment could provide the additional long-term prognostic information to AKI in pts admitted with ADHF.
- © 2013 by American Heart Association, Inc.