Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Abstract

Background: We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). Summary: We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOS_ICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOS_hosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOS_ICU = 10.6 days and that of LOS_hosp = 20.2 days). Key Messages: Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.

Risk Factors and Prognosis of Cardiorenal Syndrome Type 1 in Elderly Chinese Patients: A Retrospective Observational Cohort Study

“…Several published observational studies showed that the incidences of CRS type 1 were 25.9%-38.9% [11][12][13][14][15]. In our study, incidence of CRS1 in elderly patients was 52.56%.…”

Hypoxia-inducible factor 1 (HIF-1) as a biomarker of acute kidney injury in patients with acute decompensation of chronic heart failure

“…Распространенность ОПП у больных с острой СН составляет от 18 до 36 % [9][10][11]. В нашем исследовании ОПП наблюдалось у 32,1 % больных с ОДХСН и, в большинстве случаев, диагностировалось в первые 48 часов госпитализации.…”

“…Динамику уровня креатинина сыворотки можно оценить только через 24-48 часов, что является основным недостатком диагностики ОПП по креатинину сыворотки. В связи с этим ведутся поиски ранних маркеров повреждения почек, и в настоящее время исследованы десятки потенциальных биомаркеров ОПП, однако во многих случаях их повышение в крови или моче неспецифично [9]. ХСН приводит к неадекватной перфузии тканей и гипоксической ишемии многих органов.…”

Urine Cofilin-1 Detection for Predicting Type 1 Cardiorenal Syndrome in the Coronary Care Unit: A Gold Nanoparticle- and Laser-Based Approach

“…Type 1 cardiorenal syndrome (CRS), or acute CRS, is defined as the development of acute kidney injury (AKI) following acute decompensated heart failure (ADHF) and exerts an enormous impact on heart failure (HF) patients when it occurs [1,2]. Type 1 CRS is fairly common, and 25% of hospitalized ADHF patients may suffer from it [1].…”