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Kidney Week

Abstract: PO0176

Clinical Trajectories of AKI and Clinical Outcomes in Acute Decompensated Heart Failure

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Garcia-Flores, Octavio Rene, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Ciudad de Mexico, Mexico
  • Vázquez-Rangel, Armando, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, Ciudad de Mexico, Mexico
Background

Cardiorenal syndrome (CRS) is a pathophysiologic disorder of the heart and kidneys, with both acute and chronic dysfunction. CRS type 1 is characterized by an acute cardiac disease leading to AKI.

Methods

This is a retrospective cohort study from Jan 2017 to Dec 2018 in 3rd level center in Mexico City. The objective was to describe the incidence and outcome of AKI in patients with CRS type 1. We divide AKI's trajectory into: ascending and descending AKI, also we used a creatinine (Cr) cut-off point of 1.5mg/dl and identified 6 trajectories. We used a Logistic regression analysis (LRA) for in-hospital mortality and length of stay.

Results

404 patients were included. Mean age 58.9 ±16.5 years, 60% were men, 27% had DM, 45% had hypertension. The incidence of AKI was 60.9% and mortality was 22%. Severe AKI in 25.5%, 36 (8.9%) required kidney replacement therapy. The incidence of ascending AKI was 29.7% and mortality In this group was 46.7%. AKI's six trajectories are shown in Figure 1. In LRA for the whole cohort, PASP >40mmHg (OR 4.82 CI 2.0-11.6 p=<0.001), NT-proBNP >10000 (OR 3.26 CI 1.61-6.57 p= 0.001), ascending AKI (OR 4.08 CI 2.11-7.88 p=0.04) were associated with mortality. In LRA for ascending AKI, BUN/Cr ratio >25 (OR 1.59 CI 1.00-2.54 p=<.001) and neutrophil/lymphocyte ratio (NLR) >6.5 (OR 2.64 CI 1.65-4.23 p=<0.001) were associated with in-hospital mortality.

Conclusion

The incidence and mortality of AKI in patients with decompensated heart failure is high. Patients with ascending AKI had a significant increase in mortality and descending AKI had a better prognosis. Different Cr trajectories indicate different outcomes, the group of patients who at the time of admission had Cr >1.5mg/dl and presented a rise during hospitalization had a worse outcome. NLR>6.5 and BUN/Cr ratio >25 are predictors of mortality.