Abstract 12708: Moderate to Severe Acute Kidney Injury During Heart Failure Treatment Provides the Additional Long-Term Prognostic Information to Hemoconcentration in Patients Admitted With Acute Decompensated Heart Failure
Backgrounds: Hemoconcentration during heart failure treatment is known to be associated withdecreased mortality in patients with acute decompensated heart failure (ADHF). On the other hand, acute kidney injury (AKI) during heart failure treatment is associated with poor outcome in pts with ADHF. However, there is no information available on the long-term prognostic significance of AKI in ADHF patients, relating to hemoconcentration.
Methods and Results: We studied 302 patients admitted with ADHF and discharged with survival. Hemoconcentation was defined as an increase in hemoglobin between admission and discharge. 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 5.0±3.2 yrs, 65 patients had cardiac death. At multivariate Cox analysis, the change of hemoglobin between admission and discharge (p=0.02) and stage 2 or 3 AKI (p=0.01) were significantly associated with cardiac death, independently of serum sodium, creatinine and BUN. In group with hemoconcentration, patients with stage 2 or 3 AKI (hazard ratio: 4.9(95%CI 1.9-12.7)) had a significant increased risk of cardiac death than pts with stage 1 and no AKI (47% vs 14% vs 16%, p<0.0001). On the other hand, in group without hemoconcentration, there was no difference in the risk of cardiac death between patients with stage 2 or 3 AKI, stage 1, and no AKI.
Conclusion: Moderate to severe AKI during heart failure treatment would provide the additional long-term prognostic information to hemoconcentration in ADHF patients.
Author Disclosures: T. Yamada: None. T. Morita: None. Y. Furukawa: None. S. Tamaki: None. Y. Iwasaki: None. M. Kawasaki: None. A. Kikuchi: None. T. Kondo: None. T. Kawai: None. S. Takahashi: None. M. Ishimi: None. H. Hakui: None. T. Ozaki: None. Y. Satoh: None. M. Seo: None. M. Fukunami: None.
- © 2014 by American Heart Association, Inc.