Abstract: TH-PO0754
AKI Incidence, Severity, and In-Hospital Outcomes in Patients with Acute Decompensated Heart Failure by Heart Failure Etiology and Ejection Fraction
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
- Haeger, Sarah, University of Washington, Seattle, Washington, United States
- Prince, David K., University of Washington, Seattle, Washington, United States
- O'Brien, Kevin D., University of Washington, Seattle, Washington, United States
- Lum, Dawn Marie, University of Washington, Seattle, Washington, United States
- Bansal, Nisha, University of Washington, Seattle, Washington, United States
Background
Acute kidney injury (AKI) is common in patients hospitalized with acute decompensated heart failure (ADHF) and portends a poor prognosis. Despite a clear link between ADHF and AKI, it remains unclear whether the incidence, severity, and outcomes of AKI differ based on HF etiology (ischemic versus non-ischemic cardiomyopathy (CM)) and ejection fraction (reduced versus preserved ejection fraction – HFrEF versus HFpEF). To address this knowledge gap, we performed a prospective observational study of patients admitted with ADHF, in which a proportion developed AKI.
Methods
400 patients admitted with ADHF were enrolled. HF etiology was determined by participant interview and the medical record. Left ventricular ejection fraction (LVEF) was determined by transthoracic echocardiography (TTE) within 24 hours of admission in 87% of participants or prior TTE in the remainder. Outcomes included AKI incidence, AKI severity, AKI resolution and in-hospital length of stay. Development and severity of AKI was determined using KDIGO definitions by creatinine and/or kidney replacement therapy need. AKI resolution was defined as an improvement in serum creatinine to within 20% baseline on the day of discharge. Data was analyzed via linear or logistic regression using both unadjusted and adjusted models.
Results
Of participants enrolled, 53.3% developed AKI on/during admission. Using an ordinal logistic regression model, the incidence and severity of AKI was similar in participants with HFpEF versus HFrEF (OR 0.99, 95% CI 0.63-1.57) and non-ischemic versus ischemic CM (OR 1.27, 95% CI 0.81-1.99). In unadjusted models only, participants with HFpEF were less likely to have resolution of AKI at discharge (OR 0.49, 95% CI 0.28-0.86) and had a shorter length of stay (mean -3.88 days, 95% CI -7.50 to -0.27). Resolution of AKI and in-hospital length of stay were similar in patients with ischemic and non-ischemic CM.
Conclusion
Incidence, severity, and resolution of AKI were similar in participants with ADHF irrespective of HF etiology and LVEF. These data emphasize the interconnectedness of kidney and heart function regardless of the cause or mechanism of heart failure. Future work is needed to better understand whether the risk factors for AKI and the pathophysiology of AKI differ by HF etiology and LVEF.
Funding
- NIDDK Support