Abstract: SA-OR103

Prospective Evaluation of AKI and Risk of Heart Failure: The ASSESS-AKI Study

Session Information

  • What Happens After AKI
    November 04, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 04:54 PM - 05:06 PM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Ikizler, Talat Alp, Vanderbilt University, Nashville, Tennessee, United States
  • Chinchilli, Vernon M., Penn State University, Hershey, Pennsylvania, United States
  • Himmelfarb, Jonathan, Kidney Research Institute, Seattle, Washington, United States
  • Kimmel, Paul L., NIDDK, Bethesda, Maryland, United States
  • Kaufman, James S., VA New York, New York, New York, United States
  • Parikh, Chirag R., Yale University, New Haven, Connecticut, United States

Group or Team Name

  • ASSESS-AKI Study Investigators
Background

Several retrospective studies suggest that acute kidney injury (AKI) is associated with excess risk of heart failure (HF), but have important methodological limitations. We prospectively evaluated whether AKI impacts subsequent risk of HF.

Methods

Individually-matched hospitalized adults with and without AKI were enrolled in a parallel cohort study from 4 centers between 2009-2015 and completed an outpatient baseline visit within 3 months of discharge. Potential hospitalized HF events were adjudicated through Feb 2017 using medical records and standardized criteria. Demographics, clinical characteristics and kidney function were obtained at baseline. Multivariable Cox proportional hazards regression was used to examine the association of AKI with HF events, overall and stratified by AKI severity and by pre-existing chronic kidney disease (CKD) status.

Results

Among 769 AKI and 769 matched non-AKI adults, baseline characteristics were similar except for higher prevalence of prior cardiovascular disease, diabetes mellitus and diagnosed sepsis during the index admission in AKI patients. During follow-up, the rate (per 100 person-years) of HF was 3.90 in AKI compared with 1.83 in matched non-AKI adults (P<0.0001). In multivariable analyses, AKI was associated with a nearly 2-fold higher rate of HF (adjusted hazard ratio [aHR] 1.85, 95% CI:1.34-2.56), with stronger associations with greater AKI severity and in those without pre-existing CKD (aHR 2.44, 1.41-4.22) vs. with pre-existing CKD (aHR 1.48, 1.00-2.21) (Figure).

Conclusion

AKI independently increases the risk of being hospitalized for HF in the presence or absence of pre-existing CKD. Studies should evaluate underlying mechanisms and whether early surveillance and intervention can prevent HF after an episode of AKI.

Multivariable associations of AKI with subsequent HF events in the ASSESS-AKI Study.

Funding

  • NIDDK Support