Abstract 14265: Moderate to Severe Acute Kidney Injury Provides the Long-term Prognostic Information in Patients Admitted for Acute Decompensated Heart Failure and Clinical Scenario 1, but not 2/3
Backgrounds: Acute kidney injury (AKI) during heart failure treatment is associated with poor outcome in patients admitted for acute decompensated heart failure (ADHF). Clinical scenario (CS) is used in the early clinical management of ADHF. However, there is no information available on the long-term prognostic significance of AKI, relating to CS classification in ADHF patients.
Methods and Results: We studied 303 ADHF patients discharged with survival. According to systolic blood pressure (SBP) at admission, these patients were classified into CS1 (SBP>140mmHg, n=162), CS2 (SBP:100-140 mmHg, n=114), and CS3(SBP<100mmHg, n=27). 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 serum creatinine level (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 patients had cardiovascular-renal poor outcome (CVR), defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. At multivariate Cox analysis, SBP (p=0.0078) and AKI (p=0.0029) were significantly associated with CVR, independently of serum sodium level and renal function. In group with CS1, patients with stage 2 or 3 AKI (adjusted HR: 4.2[1.4-25.8]) had a significant increased risk of CVR, compared to patients with no AKI, while there was no significant difference in the risk between patients with stage 1 AKI and no AKI. On the other hand, in groups with CS2 or CS3, AKI stages were not significantly associated with CVR.
Conclusion: Moderate to severe AKI during heart failure treatment would provide the long-term prognostic information in ADHF patients presenting CS1, but not CS2 and CS3. These results suggested that AKI which occurred in the setting without lower SBP would have the long-term prognostic value 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. Ozaki: None. Y. Sato: None. M. Seo: None. I. Ikeda: None. E. Fukuhara: None. M. Abe: None. J. Nakamura: None. J. Nakamura: None. M. Fukunami: None.
- © 2016 by American Heart Association, Inc.