Kidney Week

Abstract: TH-PO0756

Effect of Infection on Decongestion and Kidney Outcomes in Patients with Cardiorenal Syndrome Type 1

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Chavez, Jonathan, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Jonathan Chavez, MD, PhD

• Alcantar Vallin, Maria de la Luz, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Maria de la Luz Alcantar Vallin, MD

• Medina, Ramon, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Ramon Medina, MD

• Navarro Blackaller, Guillermo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Navarro Blackaller, MD

• Garcia-Garcia, Guillermo, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Garcia-Garcia, MD, FASN

• Gómez, Juan Alberto, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Juan Alberto Gómez, MD

• Arizaga Napoles, Manuel, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Manuel Arizaga Napoles, MD

• Renoirte, Karina, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Karina Renoirte, PhD

• Martínez Gallardo González, Alejandro, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Alejandro Martínez Gallardo González

• Mendoza Gaitán, Héctor Eduardo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Héctor Eduardo Mendoza Gaitán, MD

Background

Infections are frequent precipitants of acute decompensated heart failure (ADHF) and may alter decongestive trajectories in patients with cardiorenal syndrome type 1 (CRS1), it may reduce diuretic efficacy and increase the risk of kidney injury. However, the impact of infection on decongestion and kidney outcomes in CRS1 remains unclear.

Methods

We conducted a prospective cohort study including 256 patients with CRS1 hospitalized at a tertiary center (2022–2024). Patients were stratified by the presence of infection, defined as clinical suspicion plus antibiotic therapy. The primary outcome was successful decongestion, assessed by symptoms, biomarkers (BNP/CA-125), and POCUS findings. Secondary outcomes included major adverse kidney events at 10 and 30 days (MAKE: death, kidney replacement therapy [KRT], or ≥25% eGFR decline).

Results

Seventy-two patients (28.1%) had infection, presenting with higher BNP (Q1 25,264 vs. Q3 13,405 pg/mL, p=0.012) and lower PaO2 (45 vs. 65.5 mmHg, p=0.019). Furosemide exposure was comparable (600 vs. 580 mg, p=0.62). Successful decongestion occurred in 61.4% of patients with infection vs. 59.8% without infection (p=0.83). Infection was not independently associated with decongestion (aOR 1.28, 95% CI 0.65–2.51) or MAKE-30 (aOR 1.26, 95% CI 0.57–2.79).

Conclusion

In CRS1, infection was associated with more severe baseline congestion but did not compromise decongestion rates or increase short-term MAKE. These findings support the notion that achieving decongestion is feasible in patients with ADHF due to infection without an incremental risk of MAKE.