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

Abstract

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.

Worsening renal failure in patients with acute heart failure: the importance of cardiac biomarkers

“…8 The components of AKI were recently introduced in the field of AHF. 11 In our previous report, AKI on admission and an increase of ≥0.3 mg/dL in the serum creatinine level during the first 5 days compared with the value on admission were independent predictors of the long-term mortality. 3,9,10 Approximately 30% of AHF patients already have AKI on admission to the intensive care unit (ICU), 3 and such a complication is strongly associated with a poor in-hospital mortality rate and long-term prognosis.…”

“…3,9,10 Approximately 30% of AHF patients already have AKI on admission to the intensive care unit (ICU), 3 and such a complication is strongly associated with a poor in-hospital mortality rate and long-term prognosis. 11 On the basis of those findings, we concluded that the presence of WRF with AKI on admission might be defined as true WRF. We further suggested the combined concept of WRF and AKI.…”

“…We already reported that AKI leads to adverse outcome in patients with AHF. 11 We performed a four-group comparison (AKI/ no-AKI and WRF/no-WRF) in that study. 10 The presence of AKI on admission was therefore suggested to be an important factor influencing the outcomes of AHF patients.…”

Plasma xanthine oxidoreductase activity in patients with decompensated acute heart failure requiring intensive care

“…Theoretically, XOR activity should be positively correlated with the serum UA levels because the production of UA requires activation of XOR. 25 Second, some of the previous studies excluded patients who had taken XOR inhibitors. 9,10,22 Nevertheless, although XOR activity and serum UA levels were significantly correlated in the present study, the correlation coefficient was not definitive [r = 0.335 (Spearman), data not shown].…”

“…Indeed, we previously reported that the majority of AHF patients also had acute kidney injury and/or worsening renal function. 25 Second, some of the previous studies excluded patients who had taken XOR inhibitors. In this present study, 18 (62.1%) of the 29 patients in the AHF group who had extremely low XOR activity (≤25 pmol/h/mL) also had a history of XOR inhibitor intake before admission.…”