Abstract: TH-PO0757
In-Hospital AKI Recovery and Long-Term Outcomes Among Adults Admitted with Acute Decompensated Heart Failure
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
- Assefa, Mahlet, University of Washington, Seattle, Washington, United States
- Prince, David K., University of Washington, Seattle, Washington, United States
- Lum, Dawn Marie, University of Washington, Seattle, Washington, United States
- O'Brien, Kevin D., University of Washington, Seattle, Washington, United States
- Bansal, Nisha, University of Washington, Seattle, Washington, United States
Background
Greater than 60% of patients admitted with acute decompensated heart failure (ADHF) are discharged with kidney dysfunction. Worsening kidney function during admission for ADHF is associated with adverse in-hospital outcomes. However, the long-term implications of the trajectory of acute kidney injury (AKI) in those with ADHF has not been extensively studied.
Methods
The Kidney Injury and Heart Failure (KIND-HF) is a prospective cohort study of 400 adult patients admitted with IV diuretic-requiring ADHF across 3 hospitals affiliated with the University of Washington, enrolled from 2020 to 2024 and followed for 12 months. AKI was defined as a creatinine increase of ≥0.3 mg/dL over 48 hours or a fold increase of 1.5-2 over 7-days. AKI recovery was defined as return of creatinine to within 20% of the baseline, pre-hospitalization value at in-hospital resolution of congestion. Co-primary outcomes were recurrent HF hospitalization and all-cause mortality. Poisson regression was used to estimate relative risks and a Fine-Gray model to assess associations between AKI recovery status and mortality, treating death prior to rehospitalization as a competing risk.
Results
Among 388 participants that survived to discharge (mean age 62.9 years, 63.7% male), 199 (51.2%) developed AKI and 85 (42.7%) of those with AKI had recovery. Participants with AKI recovery had lower prevalence of diabetes (36.5% vs 46.5%) but higher prevalence of chronic kidney disease (54.1% vs 45.6%) when compared to those without recovery. Compared to those without AKI, there was no significant association between AKI recovery status and risk of recurrent HF hospitalization (aRR 0.97 and 1.09, 95% CI 0.85-1.10 and 0.98-1.21 respectively). While the risk of all-cause mortality was higher in those with AKI compared to those without AKI regardless of recovery status, this risk was attenuated following adjustment for baseline eGFR, demographic and comorbid factors (aRR 1.22 and 1.40, 95% CI 0.69-2.17 and 0.80-2.43 respectively).
Conclusion
In patients admitted with ADHF, there were no significant differences in 1-year risk for recurrent HF hospitalization or all-cause mortality when comparing those with and without in-hospital AKI recovery. This suggests that AKI measured by creatinine in the setting of ADHF may not have significant prognostic implications and may instead reflect hemodynamic changes.
Funding
- NIDDK Support