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Kidney Week

Abstract: FR-OR10

Heart Failure with Preserved Ejection Fraction (HFpEF) vs. Heart Failure with Reduced Ejection Fraction (HFrEF) After AKI 

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Birkelo, Bethany, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Greevy, Robert, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Guide, Andrew, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Matheny, Michael Edwin, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Richardson, Trey Howard, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Brittain, Evan, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Siew, Edward D., Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

There is an increased risk of incident heart failure (HF) after acute kidney injury (AKI). Preclinical studies have shown AKI causes structural changes and diastolic dysfunction. The nature and phenotype of HF experienced by AKI survivors is unknown.

Methods

We conducted a case control study of adults at Vanderbilt University Medical Center. To ensure patients had established care at VUMC, we required at least one outpatient serum creatinine at least two years prior to the code for HF. Eligible patients were also required to have an echocardiogram within 30 days before or 1 year after HF diagnosis to determine HF subtype. Patients with a history of ESRD were excluded. The primary exposure was hospitalized AKI defined using creatinine-based KDIGO definitions during the exposure ascertainment period. The primary outcome was determined as HF, defined by either 1 inpatient or 2 outpatient diagnosis codes and classified using the echocardiogram closest to the HF diagnosis date (HFpEF if EF ≥45%, HFrEF if EF <45%). Baseline vitals, conditions, and medications were ascertained prior to AKI. Multivariable logistic regression was used to estimate the odds of AKI prior to HFpEF versus HFrEF.

Results

We identified 7,509 adults with incident HF (5,544 HFpEF, 1,965 HFrEF). AKI (stages 1-3) was associated with a 20% higher odds of HFpEF which was not statistically significant (OR 0.80, 95% CI 0.62 – 1.03). Stage 1 AKI was associated with a 40% higher odds of HFpEF (OR for HFrEF 0.60, 95% CI 0.42 – 0.85) whereas Stage 2-3 AKI was associated with a 17% higher odds of HFrEF, though this finding was not statistically significant (OR 1.17, 95% CI 0.81 – 1.68).

Conclusion

Stage 1 AKI was preferential towards incident HFpEF compared to HFrEF, with an association on par with other HFpEF risk factors such as female sex, obesity, atrial fibrillation, and hypertension. More severe AKI trended towards favoring HFrEF. Multimorbidity increases risk of HFpEF and may render patients susceptible to small fluctuations in serum creatinine when hospitalized. Further work is needed to elucidate mechanisms of this relationship.

Funding

  • Other NIH Support