Kidney Week

Abstract: TH-PO0755

Reevaluating Serum Creatinine Elevation During Decongestion: Prognostic Implications in Type 1 Cardiorenal Syndrome

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

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

Ramon Medina, MD

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

Jonathan Chavez, MD, PhD

• De la Torre De la Vega, Ixchel, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Ixchel De la Torre De la Vega, MD

• Martínez Aguilar, Alma Isela, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Alma Isela Martínez Aguilar, MD

• Cruz Aragon, Fernando, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Fernando Cruz Aragon, MD

• Tanaka-Gutiérrez, Jarumi Andrea, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Jarumi Andrea Tanaka-Gutiérrez

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

Guillermo Navarro Blackaller, MD

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

Maria de la Luz Alcantar Vallin, MD

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

Alejandro Martínez Gallardo González

• Abundis Mora, Gabriela Jazmín, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Gabriela Jazmín Abundis Mora, MD

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

Juan Alberto Gómez, MD

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

Karina Renoirte, PhD

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

Héctor Eduardo Mendoza Gaitán, MD

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

Manuel Arizaga Napoles, MD

Background

In type 1 cardiorenal syndrome (CRS1), mild increases in serum creatinine (sCr) during decongestive therapy are common and often attributed to functional hemodynamic changes. However, the prognostic value of more severe sCr elevations remains uncertain.

Methods

We conducted a prospective cohort study of hospitalized patients with CRS1, categorized by the presence or absence of effective clinical decongestion. The primary outcome was the occurrence of major adverse kidney events at 10 days (MAKE10), defined as death, initiation of kidney replacement therapy (KRT), or a ≥25% decline in estimated glomerular filtration rate (eGFR). Secondary outcomes included MAKE at 30 and 30–90 days.

Results

A total of 165 patients were included (median age 65.5 years; 46% female). Mean sCr increase from minimum to peak during decongestion was 2.1±1.8 mg/dL, with 94% showing ≥0.5 mg/dL increase. MAKE10 occurred in 84% of patients. Peak sCr was independently associated with MAKE10 (OR 1.49 per 1 mg/dL; 95% CI 1.05–2.13; p=0.02) and MAKE30–90 (OR 1.33; 95% CI 1.09–1.63; p=0.005), especially when exceeding 3–4 mg/dL. This was mainly driven by higher KRT initiation rates. Peak sCr was not independently associated with mortality; however, mortality was significantly higher in patients with substantial sCr elevation and no decongestion (p=0.042).

Conclusion

Severe sCr elevations during CRS1 decongestion are not uniformly benign. While mild increases may reflect expected functional changes, elevations beyond 3–4 mg/dL are associated with greater risk of MAKE, particularly due to increased KRT requirement.