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. 2022 Jan 3;7(3):526-536.
doi: 10.1016/j.ekir.2021.12.033. eCollection 2022 Mar.

Acute Kidney Disease After Acute Decompensated Heart Failure

Jia-Jin Chen  1   2 , Tao-Han Lee  1   2   3 , George Kuo  1 , Chieh-Li Yen  1 , Shao-Wei Chen  4   5 , Pao-Hsien Chu  6 , Pei-Chun Fan  1   2   7 , Victor Chien-Chia Wu  6 , Chih-Hsiang Chang  1   2   7
Affiliations

Acute Kidney Disease After Acute Decompensated Heart Failure

Jia-Jin Chen et al. Kidney Int Rep. .

Abstract

Introduction: Acute kidney disease (AKD) represents a continuum of kidney injury for 7 to 90 days after acute kidney injury (AKI). The incidence and prognosis of AKD after acute decompensated heart failure (ADHF) are currently unclear. The aims of this study were to explore the incidence of AKD and the transition from AKI to AKD, to identify risk factors for AKD and develop a prediction model for any-stage AKD, and to evaluate the prognosis of AKD.

Methods: A total of 7519 patients admitted for ADHF between January 1, 2008, and December 31, 2018, from a multi-institutional database were identified. The composite outcomes after ADHF were stage 3 AKD and all-cause death. The prognosis impact of AKD, including major adverse kidney events (MAKEs), all-cause death, and heart failure hospitalization (HFH), during 5 years of follow-up was analyzed.

Results: The overall incidence of AKI and AKD after ADHF was 9% and 21.2%, respectively; 39.4% of the patients diagnosed with having AKI during ADHF subsequently developed AKD whereas 19.4% of the patients without an identified AKI episode subsequently developed AKD. The predictive scoring models revealed C-statistics of 0.726 (95% CI: 0.712-0.740) for any-stage AKD and 0.807 (95% CI: 0.793-0.821) for the composite of stage 3 AKD and death. Finally, AKD was associated with higher risks of all-cause death, MAKE, and HFH during the 5 years of follow-up (P < 0.001).

Conclusion: AKD after ADHF are associated with adverse outcomes. Our model could help in identification of patients at risk for AKD development, especially in those who did not have an index AKI episode.

Keywords: acute decompensated heart failure; acute kidney disease; acute kidney injury.

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Figures

None
Graphical abstract
Figure 1
Figure 1
The flowchart for (a) patient selection and (b) the distribution of different AKI and AKD stages. AKD, acute kidney disease; AKI, acute kidney injury; ECMO, extracorporeal membrane oxygenation; ESRD, end-stage renal disease; RRT, renal replacement therapy.
Figure 2
Figure 2
Summary of any-stage AKD prediction model. (a) Point values for each variable. (b) Predicted risk for any-stage AKD development. AKD, acute kidney disease; AKI, acute kidney injury; BNP, B-type natriuretic peptide; CKD, chronic kidney disease.
Figure 3
Figure 3
Summary of stage 3 AKD or mortality prediction model. (a) Point values for each variable. (b) Predicted risk for stage 3 AKD development. AKD, acute kidney disease; AKI, acute kidney injury; BNP, B-type natriuretic peptide; BUN, blood urea nitrogen.
Figure 4
Figure 4
The cumulative event rate function of all-cause death (a) and MAKE (b) and cumulative incidence function of HFH (c) of patients stratified by AKD status during 5 years of follow-up. In the analysis of HFH, patients who were readmitted owing to heart failure within 90 days after discharge from the index admission were excluded from the analysis. AKD, acute kidney disease; HFH, heart failure hospitalization; MAKE, major adverse kidney event.
See this image and copyright information in PMC

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