Decompensated Heart Failure and Renal Failure: What Is the Current Evidence?

Bielecka‐Dąbrowa, Agata; Godoy, Breno; Schefold, Joerg C.; Koziolek, Michael; Banach, Maciej; Haehling, Stephan von

doi:10.1007/s11897-018-0397-5

Cited by 21 publications

(28 citation statements)

References 110 publications

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“…Patients admitted to hospital with heart failure commonly have some degree of renal dysfunction. [25] Worsening renal function is one of the most important prognostic variables in heart failure patients. [26] The impaired renal clearance and upregulation of xanthine oxygenase can be responsible for elevated uric acid level.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of serum uric acid in patients with acute heart failure

Huang¹,

Qin

Deng³

et al. 2019

Medicine

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Background: Conflicting results have been reported on the prognostic significance of serum uric acid (SUA) in patients with acute heart failure (AHF). This meta-analysis aimed to determine the prognostic significance of SUA level in patients with AHF. Methods: We made a comprehensive literature search in Pubmed and Embase databases from inception to April 6, 2018. All available observational studies or post hoc analysis of randomized controlled trial that evaluated the prognostic value of SUA level in patients with AHF were eligible. Outcome of interests were all-cause mortality and the combined endpoint of death or readmission. Prognostic values of SUA level were summarized as higher vs lower SUA category or per 1 mg/ml SUA rise. Results: Ten studies involving 12,854 AHF patients were identified and analyzed. AHF patients with the highest SUA level had an increased risk of all-cause mortality (risk ratio [RR] 1.43; 95% confidence intervals [CI] 1.31–1.56) and combined endpoint of death or readmission (RR 1.68; 95% CI 1.33–2.13) after adjusting potential variables. In addition, per 1 mg/ml SUA rise significantly increased by 11% and 12% higher risk all-cause mortality and combined endpoint of death or readmission, respectively. A leave out 1 study sensitivity analysis confirmed the reliability of the pooling effect sizes. Conclusion: This meta-analysis indicates that elevated SUA level independently predicts all-cause mortality and the combined endpoint of death or readmission in AHF patients. Measurement of SUA level may improve risk stratification of adverse outcomes in these patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of serum uric acid in patients with acute heart failure

Huang¹,

Qin

Deng³

et al. 2019

Medicine

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“…In patients with HF, the incidence and impact of AKI have been reported mainly in subjects hospitalized with acute HF (AHF), in which the prevalence of AKI is ~20%, and it has been recognized that AKI is a strong independent predictor of both in‐hospital and 1‐year mortality . A meta‐analysis of cohorts, registries, and post‐hoc studies concluded that CKD and worsening of renal function (WRF), a term that has been used instead of AKI in HF patients, are frequently observed in patients with HF. However, the authors acknowledge heterogeneity due to different inclusion criteria, selection bias, and different definitions and criteria used to qualify AKI .…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in heart failure: a population study

et al. 2020

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AimsThe objective of the present study is to assess the prognostic value of acute kidney injury (AKI) in the evolution of patients with heart failure (HF) using real-world data. Methods and results Patients with a diagnosis of HF and with serial measurements of renal function collected throughout the study period were included. Estimated glomerular filtration rate (GFR) was calculated with the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). AKI was defined when a sudden drop in creatinine with posterior recovery was recorded. According to the Risk, Injury, Failure, Loss, and End-Stage Renal Disease (RIFLE) scale, AKI severity was graded in three categories: risk [1.5-fold increase in serum creatinine (sCr)], injury (2.0-fold increase in sCr), and failure (3.0-fold increase in sCr or sCr > 4.0 mg/dL). AKI incidence and risk of hospitalization and mortality after the first episode were calculated by adjusting for potential confounders. A total of 30 529 patients with HF were included. During an average follow-up of 3.2 years, 5294 AKI episodes in 3970 patients (13.0%) and incidence of 3.3/100 HF patients/year were recorded. One episode was observed in 3161 (10.4%), two in 537 (1.8%), and three or more in 272 (0.9%). They were more frequent in women with diabetes and hypertension. The incidence increases across the GFR levels (Stages 1 to 4: risk 7.6%, 6.8%, 11.3%, and 12.5%; injury 2.1%, 2.0%, 3.3%, and 5.5%; and failure 0.9%, 0.6%. 1.4%, and 8.0%). A total of 3817 patients with acute HF admission were recorded during the follow-up, with incidence of 38.4/100 HF patients/year, 3101 (81.2%) patients without AKI, 545 (14.3%) patients with one episode, and 171 (4.5%) patients with two or more. The number of AKI episodes [one hazard ratio (HR) 1.05 (0.98-1.13); two or more HR 2.01 (1.79-2.25)] and severity [risk HR 1.05 (0.97-1.04); injury HR 1.41 (1.24-1.60); and failure HR 1.90 (1.64-2.20)] increases the risk of hospitalization. A total of 10 560 deaths were recorded, with incidence of 9.3/100 HF patients/year, 8951 (33.7%) of subjects without AKI episodes, 1180 (11.17%) of subjects with one episode, and 429 (4.06%) with two or more episodes. The number of episodes [one HR 1.05 (0.98-1.13); two or more HR 2.01 (1.79-2.25)] and severity [risk 1.05 confidence interval (CI) (0.97-1.14), injury 1.41 (CI 1.24-1.60), and failure 1.90 (CI 1.64-2.20)] increases mortality risk. Conclusions The study demonstrated the worse prognostic value of sudden renal function decline in HF patients and pointed to those with more future risk who require review of treatment and closer follow-up.

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“…Gastrointestinal reflux, duodenal ulcers, and angiodysplasia occur in more than 30% of this aged population [8,20]. In addition, patients with HF are at risk of developing AKI [21], due to a low cardiac output or congestive status, as well as the use of drugs blocking the renin-angiotensin system or diuretics. In an AKI condition, Hb falls is an accompanying element [21], mainly in the most severe classes, and increase the burden to the heart [18].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, patients with HF are at risk of developing AKI [21], due to a low cardiac output or congestive status, as well as the use of drugs blocking the renin-angiotensin system or diuretics. In an AKI condition, Hb falls is an accompanying element [21], mainly in the most severe classes, and increase the burden to the heart [18]. Whether the incidence of hospitalization or mortality was higher in patients with a reduced left ventricular ejection fraction than in those with a preserved ejection fraction was not possible to assess in the present study, due to the low number of left ventricular functions recorded in the EHR.…”

Section: Discussionmentioning

confidence: 99%

Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study

Lopez

Holgado

Fernández

et al. 2020

JCM

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Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, representing 3.6/100 HF patients/year. The risk of hospitalization increased with one episode (Hazard Ratio = 1.30, 95% confidence interval (CI) 1.19–1.43), two or more episodes (HR = 1.59, 95% CI 1.14–2.23, and concurrent AKI (HR = 1.61, 95% CI 1.27–2.03). A total of 10,490 patients have died, representing 8.1/100 HF patients/year. The risk of mortality was HR = 2.20 (95% CI 2.06–2.35) for one episode, HR = 3.14 (95% CI 2.48–3.97) for two or more episodes, and HR = 3.20 (95% CI 2.73–3.75) with AKI. In the two or more episodes and AKI groups, Hb levels at the baseline were significantly lower (10.2–11.4 g/dL) than in the no episodes group (12.8 g/dL), and a higher and significant mortality in these subgroups was observed. Conclusions: Hb falls in heart failure patients identified those with a worse prognosis requiring a more careful evaluation and follow-up.

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Decompensated Heart Failure and Renal Failure: What Is the Current Evidence?

Cited by 21 publications

References 110 publications

Prognostic value of serum uric acid in patients with acute heart failure

Prognostic value of serum uric acid in patients with acute heart failure

Acute kidney injury in heart failure: a population study

Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study

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