Additive harmful effects of acute kidney injury and acute heart failure on mortality in hospitalized patients

Abstract

Background: Organ crosstalk between the kidney and the heart has been suggested. Acute kidney injury (AKI) and acute heart failure (AHF) are well-known independent risk factors for mortality in hospitalized patients. This study aimed to investigate if these conditions have an additive effect on mortality in hospitalized patients, as this has not been explored in previous studies. Methods: We retrospectively reviewed the records of 101,804 hospitalized patients who visited two tertiary hospitals in the Republic of Korea over a period of 5 years. AKI was diagnosed using serum creatinine-based criteria, and AHF was classified using International Classification of Diseases codes within 2 weeks after admission. Patients were divided into four groups according to the two conditions. The primary outcome was all-cause mortality. Results: AKI occurred in 6.8% of all patients (n = 6,920) and AHF in 1.2% (n = 1,244). Three hundred thirty-one patients (0.3%) developed both conditions while AKI alone was present in 6,589 patients (6.5%) and AHF alone in 913 patients (0.9%). Among the 5,181 patients (5.1%) who died, 20.8% died within 1 month. The hazard ratio for 1-month mortality was 29.23 in patients with both conditions, 15.00 for AKI only, and 3.39 for AHF only. The relative excess risk of interaction was 11.85 (95% confidence interval, 2.43-21.27), and was more prominent in patients aged <75 years and those without chronic heart failure. Conclusion: AKI and AHF have a detrimental additive effect on short-term mortality in hospitalized patients.

Artificial Intelligence in Heart Failure and Acute Kidney Injury: Emerging Concepts and Controversial Dimensions

“…Indeed, AKI is a robust independent predictor for both in-hospital and 1-year mortality for HF patients [1,3]. AKI is independently associated with a higher risk of cardiovascular events, especially recurrent HF, after hospital discharge [4][5][6][7]. This relationship is also associated with a higher likelihood of chronic kidney disease (CKD), expedited progression to end-stage renal disease, and a decline in health-related quality of life [2,8].…”

Intradialytic hypotension and worse outcomes in patients with acute kidney injury requiring intermittent hemodialysis

“…In patients with severe AKI requiring renal replacement therapy, the rate of in-hospital mortality has been reported to be 50% to 60% over the past two decades [2,3]. For those who survive, the AKI episode confers a risk of several complications, including progression to chronic kidney disease and subsequent events such as myocardial infarction and congestive heart failure [4][5][6][7][8].…”

On operational definitions of mortality

“…Mortality stands as a cornerstone parameter in biomedical research [ 6 , 7 ]. Sometimes, addressing critical scientific inquiries becomes infeasible without knowledge of mortality rates.…”