Prognostic Impact of Acute Kidney Injury in Patients With Acute Decompensated Heart Failure

Shirakabe, Akihiro; Hata, Noritake; Kobayashi, Nobuaki; Shinada, Tetsuro; Tomita, Kazunori; Tsurumi, Masafumi; Matsushita, M.; Okazaki, Hirokake; Yamamoto, Yoshiya; Yokoyama, Shinya; Asai, Kuniya; Mizuno, Kyoichi

doi:10.1253/circj.cj-12-0994

Cited by 75 publications

(59 citation statements)

References 36 publications

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“…Although most patients who develop acute CRS experience a mild form of AKI (e.g., Kidney Disease Improving Global Outcomes [KDIGO] or Acute Kidney Injury Network [AKIN] stage 1 or RIFLE R) and do not progress to more severe AKI (KDIGO/AKIN stage 2/3 or RIFLE F) or require dialysis, approximately 29%-48% of these patients progress to a higher stage of AKI (8,9). Recent studies have demonstrated that risk of mortality exponentially increased with increasing stages of AKI in the setting of ADHF (10).…”

Section: Introductionmentioning

confidence: 99%

Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome

Chen¹,

Yang

Lei

et al. 2016

CJASN

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Background and objectives A major challenge in early treatment of acute cardiorenal syndrome (CRS) is the lack of predictors for progression of AKI. We aim to investigate the utility of urinary angiotensinogen and other renal injury biomarkers in predicting AKI progression in CRS.Design, settings, participants, & measurements In this prospective, multicenter study, we screened 732 adults who admitted for acute decompensated heart failure from September 2011 to December 2014, and evaluated whether renal injury biomarkers measured at time of AKI diagnosis can predict worsening of AKI. In 213 patients who developed Kidney Disease Improving Global Outcomes stage 1 or 2 AKI, six renal injury biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), plasma neutrophil gelatinase-associated lipocalin, urinary IL-18 (uIL-18), urinary kidney injury molecule-1, and urinary albumin-to-creatinine ratio, were measured at time of AKI diagnosis. The primary outcome was AKI progression defined by worsening of AKI stage (50 patients). The secondary outcome was AKI progression with subsequent death (18 patients).Results After multivariable adjustment, the highest tertile of three urinary biomarkers remained associated with AKI progression compared with the lowest tertile: uAGT (odds ratio [OR], 10.8; 95% confidence interval [95% CI], 3.4 to 34.7), uNGAL (OR, 4.7; 95% CI, 1.7 to 13.4), and uIL-18 (OR, 3.6; 95% CI, 1.4 to 9.5). uAGT was the best predictor for both primary and secondary outcomes with area under the receiver operating curve of 0.78 and 0.85. These three biomarkers improved risk reclassification compared with the clinical model alone, with uAGT performing the best (category-free net reclassification improvement for primary and secondary outcomes of 0.76 [95% CI, 0.46 to 1.06] and 0.93 [95% CI, 0.50 to 1.36]; P,0.001). Excellent performance of uAGT was further confirmed with bootstrap internal validation.Conclusions uAGT, uNGAL, and uIL-18 measured at time of AKI diagnosis improved risk stratification and identified CRS patients at highest risk of adverse outcomes.

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Section: Introductionmentioning

confidence: 99%

Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome

Chen¹,

Yang

Lei

et al. 2016

CJASN

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“…The RIFLE criteria have been established as the standard method for evaluating AKI in intensive care patients 5, 6. Based on the wealth of evidence in the intensive care field, we suggested the prognostic efficacy of the AKI criteria in patients with AHF 7, 8, 9. The AKI criteria have been adequately established in intensive care patients; therefore, it would be reasonable to use these criteria for the evaluation of acute renal failure for AHF patients.…”

Section: Discussionmentioning

confidence: 99%

“…In these reports, the component of acute kidney injury (AKI) was suggested for the evaluation of acute renal failure. We previously reported that patients with AKI, particularly those with a Class I or F status, exhibit a worse long‐term prognosis than no‐AKI patients among subjects with AHF 7, 8. Furthermore, 33.2% of AHF patients already have AKI upon admission to the intensive care unit (ICU),7 which is associated with a poor in‐hospital mortality rate and long‐term prognosis 9.…”

Section: Introductionmentioning

confidence: 99%

Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure

et al. 2018

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AimsWhether or not the definition of a worsening renal function (WRF) is adequate for the evaluation of acute renal failure in patients with acute heart failure is unclear.Methods and resultsOne thousand and eighty‐three patients with acute heart failure were analysed. A WRF, indicated by a change in serum creatinine ≥0.3 mg/mL during the first 5 days, occurred in 360 patients while no‐WRF, indicated by a change <0.3 mg/dL, in 723 patients. Acute kidney injury (AKI) upon admission was defined based on the ratio of the serum creatinine value recorded on admission to the baseline creatinine value and placed into groups based on the degree of AKI: no‐AKI (n = 751), Class R (risk; n = 193), Class I (injury; n = 41), or Class F (failure; n = 98). The patients were assigned to another set of four groups: no‐WRF/no‐AKI (n = 512), no‐WRF/AKI (n = 211), WRF/no‐AKI (n = 239), and WRF/AKI (n = 121). A multivariate logistic regression model found that no‐WRF/AKI and WRF/AKI were independently associated with 365 day mortality (hazard ratio: 1.916; 95% confidence interval: 1.234–2.974 and hazard ratio: 3.622; 95% confidence interval: 2.332–5.624). Kaplan–Meier survival curves showed that the rate of any‐cause death during 1 year was significantly poorer in the no‐WRF/AKI and WRF/AKI groups than in the WRF/no‐AKI and no‐WRF/no‐AKI groups and in Class I and Class F than in Class R and the no‐AKI group.ConclusionsThe presence of AKI on admission, especially Class I and Class F status, is associated with a poor prognosis despite the lack of a WRF within the first 5 days. The prognostic ability of AKI on admission may be superior to WRF within the first 5 days.

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“…However, patients with heart failure with reduced ejection fraction and severe renal insufficiency (creatinine clearance <30 mL/min) who were treated in-hospital with a reninangiotensin-aldosterone system antagonist appear to have been better 1-year survival, [38] suggesting that such an approach should not be absolute. Despite this, ACE-inhibitors and angiotensin receptor blockers are administered less frequently during heart failure hospitalizations in patients with severe kidney dysfunction, [39,40] and more data are needed if current recommendations and clinical practice are to be altered. Mineralocorticoid receptor antagonists have been shown in subgroup analyses to confer mortality benefit in patients with renal dysfunction and moderate to severe heart failure.…”

Section: Other Considerationsmentioning

confidence: 99%

Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society of Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group

Collins

Levy

Martindale

et al. 2016

Journal of Cardiac Failure

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Prognostic Impact of Acute Kidney Injury in Patients With Acute Decompensated Heart Failure

Cited by 75 publications

References 36 publications

Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome

Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome

Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure

Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society of Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group

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