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Kidney Week

Abstract: PO0175

Additive Harmful Effects of AKI and Acute Heart Failure on Mortality in Hospitalized Patients

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Son, Hyung Eun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Baek, Eunji, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Ryu, Ji Young, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Jeong, Jong Cheol, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Chae, Dong-Wan, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Han, Seung Seok, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
Background

Organ crosstalk between kidney and heart has been suggested. This study aimed to investigate the additive effect of both conditions on mortality.

Methods

We retrospectively recruited 102,721 hospitalized patients for 5 years. Acute kidney injury was diagnosed with serum creatinine-based criteria, and acute heart failure with International Classification of Diseases code, within two weeks after admission. Primary outcome was all-cause mortality.

Results

Among the 5,316 (5.2%) patients who died, 20.5% died within 1 month. Hazard ratio for 1-month mortality was 23.25 in patients with both conditions, 13.47 for acute kidney injury only, and 2.76 for acute heart failure only. The relative excess risk of interaction was 8.01, and it was more prominent in patients aged <75 years, and those without chronic heart failure.

Conclusion

Acute kidney injury and acute heart failure had a detrimental additive effect on short-term mortality in hospitalized patients.

Results of analyses on interaction, where AKI and AHF are the two exposures of interest to mortality within 1 month
 No AKIAKIHRs (95% CI) for AKI within strata of AHF
 nHR (95% CI)nHR (95% CI) 
No AHF494/94,0461.000 (Ref)523/7,39314,846 (12.957-17.010)14.846 (12.957-17.010)
AHF21/9133.292 (2.042-5.308)53/36928.591 (20.478-39.917)14.425 (12.627-16.479)
HRs (95% CI) for AHF within strata of AKI 3.292 (2.042-5.308) 2.168 (1.624-2.895) 

Relative excess risk of interaction (95% CI) = 11.453 (2.386-20.520); P = 0.013. Attributable proportion due to interaction (95% CI) = 0.401 (0.208-0.594); P <0.001 Synergy index (95% CI) = 1.710 (1.224-2.388); P = 0.002. AKI, acute kidney injury; AHF, acute heart failure; HR, hazard ratio; CI; confidence interval.

Kaplan-Meier curves for death by groups, based on presence of AKI or AHF

HRs of death within 1 month in subgroups