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Kidney Week

Abstract: PO0078

Short-Term Prognosis of Patients with Cardiorenal Syndrome Type 1-Induced AKI Requiring Continuous Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Watanabe, Yusuke, Saitama Medical University, Iruma-gun, Saitama, Japan
  • Sugiyama, Kei, Saitama Medical University, Iruma-gun, Saitama, Japan
  • Fukaya, Daichi, Saitama Medical University, Iruma-gun, Saitama, Japan
  • Amano, Hiroaki, Saitama Medical University, Iruma-gun, Saitama, Japan
  • Inoue, Tsutomu, Saitama Medical University, Iruma-gun, Saitama, Japan
  • Okada, Hirokazu, Saitama Medical University, Iruma-gun, Saitama, Japan
Background

Cardio-renal syndrome (CRS) type 1 is a condition wherein an acute heart failure (AHF) leads to the development of acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) is used to remove excess solutes and fluids in CRS type 1 patients who have diuretic resistance. However, little is known about the outcomes of CRS type 1 patients who undergo CRRT.

Methods

We reviewed the clinical data of 74 consecutive CRS type 1 patients treated with CRRT from 2012 to 2015. Patients who underwent cardiovascular surgery and those who had chronic kidney disease stage 5 prior to admission were excluded. The primary outcome examined was in-hospital mortality.

Results

The mean age of patients was 70.6 ± 13.6 years old. The causes of AHF were ischemic heart disease (54.1%), valvular disease (13.5%), and other diseases. At the time of the CRRT initiation, the mean serum creatinine was 2.8 ± 1.0 mg/dL. The in-hospital mortality rate was 77.0%. Compared with non-survivors, the survivors had fewer number of previous hospitalizations for heart failure (50.9% vs. 23.5 %, p = 0.046), higher systolic blood pressure (97.7 ± 22.2 mmHg vs. 112.3 ± 21.1 mmHg, p = 0.02), better ejection fraction (31.4 ± 17.9% vs. 42.0 ± 15.7%, p = 0.03), smaller inferior vena cava (IVC) diameter (18.0 ± 5.8 mm vs. 14.8 ± 4.4 mm, p = 0.04), lesser respiratory variations in the IVC diameter (59.6% vs. 13.3 %, p = 0.002), lesser vasopressor requirement (96.5% vs. 31.9%, p = 0.001), and lesser respirator support (56.1% vs. 23.5%, p = 0.02) at CRRT initiation. The survivors required a shorter CRRT duration over the non-survivors (6.1 ± 6.9 days vs. 11.7 ± 12.4 days, p = 0.03). Through the multiple logistic regression analysis, certain factors were associated with a poor short-term prognosis. These factors were history of previous hospitalizations for heart failure, vasopressor requirement upon the start of CRRT, and the need for respirator support at CRRT initiation.

Conclusion

In our single-center experience, the use of CRRT for treating AKI caused by CRS type 1 was associated with a high in-hospital mortality rate. Patients with a history of previous hospitalization for heart failure, those who required vasopressors, and patients needing respirator support at CRRT initiation had an especially poorer prognosis.