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Kidney Week

Abstract: FR-PO100

AKI in Patients with Acute Decompensated Heart Failure Undergoing Aggressive Diuresis and Its Effect on Short-Term Outcome

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Jhajhria, Anil Kumar, Max Super Speciality Hospital Vaishali, Ghaziabad, Uttar Pradesh, India
  • Singhal, Manoj, Max Super Speciality Hospital Vaishali, Ghaziabad, Uttar Pradesh, India
  • Gaur, Lovy, Max Super Speciality Hospital Vaishali, Ghaziabad, Uttar Pradesh, India
  • Dassi, Manisha, Max Super Speciality Hospital Vaishali, Ghaziabad, Uttar Pradesh, India
Background

Acute heart failure (AHF) patients treated with diuretics often develop worsening of renal functions with resultant acute kidney injury (AKI) during hospitalization. AKI could be a result of renal tubular injury or simply indicate a hemodynamic / functional change in glomerular filtration.

Methods

100 AHF patients who underwent aggressive diuresis were included (excluding patients requiring inotropic support or haemodialysis). Urine NGAL was measured on the day of admission and after 72 hours. Serum creatinine was measured on day of admission, at 48 hours and at 72 hours post admission. AKI was defined as per KDIGO guideline as increase in creatinine by 0.3mg/dL or more in 48 hours or urine output < 0.5 mL/kg/h for 6 hours. All patients were contacted at 30 days and reviewed regarding requirement of readmission/mortality. Patients who developed AKI got their creatinine checked again at day 30 from the day of admission.

Results

Mean eGFR of patients was 48.1 ml/min/m2 . Mean NT-proBNP was 11000 pg/ml. Mean LVEF was 43%, with 38% patients having HFrEF and 62% patients had HFpEF. Of total 100 patients, 37 developed AKI. Rise in NGAL from day 0 to day 3 was noted in 34 cases. There was no correlation found between rising creatinine levels and rising NGAL levels (including patients with AKI). Mean NT-proBNP was higher in patients with AKI as compared to those without AKI (p-value=0.048). Of 37 AKI patients, 10 (27%) patients had creatinine value at day 30 higher than at day 3, while 27 (73%) patients had creatinine value at day 30 lower than at day 3. 30 patients needed readmission within 30 days after discharge; 5 patients expired by day 30. Occurrence of AKI did not show association with readmission within 30 days or with mortality at 30 days.

Conclusion

AKI occurred in 37% patients with AHF undergoing aggressive diuresis. This AKI had no correlation with serial NGAL levels (tubular injury biomarker) but was associated with elevated baseline NT-proBNP levels. 73% AKI patients showed improvement in creatinine levels by day 30 post discharge & occurrence of AKI did not affect short term morbidity (readmission at 30 days) and mortality at 30 days. This implies that AKI in the setting of AHF & aggressive diuresis is mild, mainly functional/hemodynamic and should not affect decisions with decongestive therapy.