Abstract 11742: Moderate to Severe Acute Kidney Injury Provides the Additional Long-Term Prognostic Information to ADHERE Risk Level in Patients Admitted With Acute Decompensated Heart Failure
Backgrounds: The Acute Decompensated Heart Failure National Registry (AHDERE) risk levels are a validated tool to assess the risk of in-hospital mortality in patients (pts) with acute decompensated heart failure (ADHF). Acute kidney injury (AKI) during heart failure treatment is also associated with poor outcome in ADHF pts. However, there is no information available on the long-term prognostic significance of AKI, relating to ADHERE risk levels in ADHF pts.
Methods and Results: We studied 305 consecutive ADHF pts discharged with survival. ADHERE risk levels were assigned, as previously described, baseline BUN(≥43 vs <43 mg/dl), systolic BP (<115 vs ≥115 mmHg), and creatinine(Cr≥2.75 vs <2.75 mg/dl). 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 Cr; stage 2, >2- to 3-fold increase in Cr; stage 3, >3-fold increase in Cr or Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). During a follow-up period of 4.1±3.2 yrs, 81 pts had cardiovascular-renal poor outcome, defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. At multivariate Cox analysis, ADHERE risk levels (p<0.0001) and AKI (p<0.0001) were significantly associated with cardiovascular-renal poor outcome, independently of age, serum sodium and hemoglobin levels. Irrespective of high/intermediate or low ADHERE risk levels, pts with stage 2 or 3 AKI (adjusted HR: 5.9[1.8-19.2] in high/intermediate riskgroup, 4.9[2.1-11.3] in low risk group) had a significant increased risk of cardiovascular-renal poor outcome, compared to pts with no AKI. On the other hand, there were no significant differences in the risk between pts with stage 1 AKI and no AKI in both groups.
Conclusion: Moderate to severe AKI during heart failure treatment would provide the additional long-term prognostic information to ADHERE risk levels in ADHF pts.
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. M. Ishimi: None. H. Hakui: None. T. Ozaki: None. Y. Satoh: None. M. Seo: None. M. Fukunami: None.
- © 2015 by American Heart Association, Inc.