Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure

Sánchez-Serna, Juan; Hernández-Vicente, Álvaro; Garrido-Bravo, Iris P.; Pastor‐Pérez, Francisco J.; Noguera-Velasco, José Antonio; Casas-Pina, Teresa; Rodriguez-Serrano, A.; Núñez, Julio; Pascual-Figal, Domingo A.

doi:10.1016/j.ejim.2020.02.028

Cited by 10 publications

(14 citation statements)

References 34 publications

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“…CKD is a frequent condition among hospitalized patients due to its close association with increasing age and various co-morbidities. This relation is particularly strong in patients with cardiovascular diseases (CVD), including acute and chronic coronary syndrome (ACS and CCS), heart failure (HF), or atrial fibrillation (AF) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Several studies emphasized the bidirectional relation between renal function and cardiovascular outcomes [5,[20][21][22] as CVD is responsible for 40-50% of all deaths in nephropathic patients [5,23,24], and CKD, even in early stages, has been related to fatal and nonfatal cardiovascular events, regardless of traditional cardiovascular risk factors [25][26][27][28][29][30][31][32].…”

Section: Introductionmentioning

confidence: 99%

Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome

Malavasi

Valenti

Ruggerini

et al. 2022

JCM

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Background: This paper aims to evaluate the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and alternative equations and to assess their predictive power for all-cause mortality in unselected patients discharged alive from a cardiology ward. Methods: We retrospectively included patients admitted to our Cardiology Division independently of their diagnosis. The total population was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) categories, as follows: G1 (estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m2); G2 (eGFR 89–60 mL/min/1.73 m2); G3a (eGFR 59–45 mL/min/1.73 m2); G3b (eGFR 44–30 mL/min/1.73 m2); G4 (eGFR 29–15 mL/min/1.73 m2); G5 (eGFR <15 mL/min/1.73 m2). Cockcroft-Gault (CG), CG adjusted for body surface area (CG-BSA), Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study (BIS-1), and Full Age Spectrum (FAS) equations were also assessed. Results: A total of 806 patients were included. Good agreement was found between the CKD-EPI formula and CG-BSA, MDRD, BIS-1, and FAS equations. In subjects younger than 65 years or aged ≥85 years, CKD-EPI and MDRD showed the highest agreement (Cohen’s kappa (K) 0.881 and 0.588, respectively) while CG showed the lowest. After a median follow-up of 407 days, overall mortality was 8.2%. The risk of death was higher in lower eGFR classes (G3b HR4.35; 95%CI 1.05–17.80; G4 HR7.13; 95%CI 1.63–31.23; G5 HR25.91; 95%CI 6.63–101.21). The discriminant capability of death prediction tested with ROC curves showed the best results for BIS-1 and FAS equations. Conclusion: In our cohort, the concordance between CKD-EPI and other equations decreased with age, with the MDRD formula showing the best agreement in both younger and older patients. Overall, mortality rates increased with the renal function decreasing. In patients aged ≥75 years, the best discriminant capability for death prediction was found for BIS-1 and FAS equations.

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Section: Introductionmentioning

confidence: 99%

Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome

Malavasi

Valenti

Ruggerini

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…In our study, AKI was independently associated with in‐hospital mortality, with a prevalence of 60.8% in patients with CHF and CKD, a surprising figure compared with approximately 30.6% in patients with HF and CKD reported by Juan et al . 14 Patients with AKI were more likely to be referred to the ICU, which may have contributed to this increase. In this study, patients with AKI had a 1.65‐fold increased risk of death.…”

Section: Discussionmentioning

confidence: 99%

A nomogram to predict the in‐hospital mortality of patients with congestive heart failure and chronic kidney disease

Chen

Liu

et al. 2022

ESC Heart Failure

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Aims Patients with congestive heart failure (CHF) may also suffer from chronic kidney disease (CKD), and the two conditions may interact to increase the risk of death. The purpose of this study was to investigate the risk factors contributing to in‐hospital mortality in patients with CHF and CKD and to develop a nomogram to predict the risk of in‐hospital mortality. Methods and results This retrospective study used data from the Marketplace for Medical Information in Intensive Care (MIMIC‐IV, version 1.0). Patients diagnosed with CHF and CKD in MIMIC‐IV were included in this study. The least absolute shrinkage and selection operator (LASSO) logistic regression is used to select risk variables for the nomogram model, and bootstrap is used for internal validation. Simplified Acute Physiology Score II (SAPS II) and Logistic Organ Dysfunction Score (LODS) were compared with the nomogram model by the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). A total of 4638 adult patients with CHF and CKD were included in the final cohort; of them, 707 (15.2%) died and 3931 (84.8%) survived during hospitalization. Our final model included the following 13 variables: age, acute kidney injury, myocardial infarction, anaemia, heart rate ≥ 100 b.p.m., systolic blood pressure ≥ 130 mmHg, anion gap (AG) ≥ 20 mEq/L, sodium ≥ 145 mEq/L, red blood cell distribution width (RDW) ≥ 15.5%, white blood cell count ≥ 10 K/μL, continuous renal replacement therapy (CRRT), angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and beta‐blocker. The corrected C‐statistic of the nomogram was 0.767, and the calibration curve indicating good concordance between the predicted and observed values. The nomogram demonstrated good accuracy for predicting the in‐hospital mortality with an AUC of 0.771 (95% CI: 0.752–0.790), while the AUC for SAPS II and LODS was 0.747 (95% CI: 0.726–0.767) and 0.752 (95% CI: 0.730–0.773), respectively. DCA found that when the threshold probability was 0.05 to 0.41, the nomogram model could provide a greater net benefit than SAPS II. Conclusions In this retrospective cohort analysis of patients with CHF and CKD, we identified 13 independent variables associated with in‐hospital mortality using LASSO logistic regression. RDW, AG, and CRRT were reported to play a significant role in in‐hospital mortality among patients with CHF and CKD for the first time. Based on a simplified model including 13 variables, a nomogram was drawn to predict the risk of in‐hospital mortality. In comparison with SAPS II and LODS, the nomogram model performed well.

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“…Single centre studies reported an increased risk of death and HF readmission among patients experiencing WRF at the time of admission with AHF; however, there are notable differences between these studies and ours. 8 , 9 , 10 One study found primarily stage 2 and 3 KDIGO AKI was associated with adverse events of death and HF readmission, but not stage 1. 9 This is similar to our findings, as the primary WRF definition captured stage 1 or greater KDIGO AKI and was not associated with outcomes, whereas more stringent criteria of WRF were associated with increased length of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, some prior studies suggest that WRF present at the time of admission with AHF is associated with an increased risk of mortality and HF readmission. 8 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

Implications of worsening renal function before hospitalization for acute heart failure

et al. 2022

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Aims Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). Methods and results We evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase–associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3 months before and at the time of admission. Admission WRF was primarily defined as a 0.3 mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5 mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in‐hospital events, and the composite of death or HF readmission at 30, 90, and 365 days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One‐hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16–1.28, 95% confidence interval [CI] 1.00–1.55) and lower diastolic blood pressure (OR 0.97–0.98, 95% CI 0.96–0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6 days longer, 95% CI 1.0–2.2). WRF across definitions was not associated with a higher odds of adverse in‐hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome. Conclusions Admission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in‐hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events.

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Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure

Cited by 10 publications

References 34 publications

Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome

Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome

A nomogram to predict the in‐hospital mortality of patients with congestive heart failure and chronic kidney disease

Implications of worsening renal function before hospitalization for acute heart failure

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