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. 2025 May 28.
doi: 10.1002/ejhf.3701. Online ahead of print.

Kidney injury in patients with heart failure-related cardiogenic shock: Results from an international, multicentre cohort study

Jonas Sundermeyer  1   2 , Caroline Kellner  1   3 , Benedikt N Beer  1   2 , Lisa Besch  1   2 , Angela Dettling  1   2 , Letizia Fausta Bertoldi  4 , Stefan Blankenberg  1   2   3 , Jeroen Dauw  5 , Dennis Eckner  6 , Ingo Eitel  2   7 , Tobias Graf  2   7 , Patrick Horn  8 , Joanna Jozwiak-Nozdrzykowska  9 , Paulus Kirchhof  1   2   3 , Stefan Kluge  10 , Axel Linke  11 , Ulf Landmesser  12 , Enzo Lüsebrink  13 , Nicolas Majunke  9 , Norman Mangner  11 , Sven Möbius Winkler  14 , Peter Nordbeck  15 , Martin Orban  13 , Federico Pappalardo  16 , Matthias Pauschinger  6 , Michal Pazdernik  17 , Alastair Proudfoot  18 , Matthew Kelham  18 , Tienush Rassaf  19 , Hermann Reichenspurner  2   20 , Clemens Scherer  13 , P Christian Schulze  14 , Robert H G Schwinger  21 , Carsten Skurk  12 , Marek Sramko  17 , Guido Tavazzi  22   23 , Holger Thiele  9 , Luca Villanova  24 , Nuccia Morici  25 , Ephraim B Winzer  11 , Dirk Westermann  26 , Benedikt Schrage  1   2
Affiliations

Kidney injury in patients with heart failure-related cardiogenic shock: Results from an international, multicentre cohort study

Jonas Sundermeyer et al. Eur J Heart Fail. .

Abstract

Aims: Heart failure-related cardiogenic shock (HF-CS) accounts for about half of CS cases, with a paucity of data regarding the role of kidney injury in this subset. This study aims to evaluate patient characteristics and outcome associated with renal function in patients with HF-CS.

Methods and results: In this multicentre, international, retrospective study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation, complications, and 30-day mortality, based on renal function, adjusted logistic and Cox regression models were fitted. Among 1010 HF-CS patients, the median age was 64 (interquartile range [IQR] 52-75) years, with 71.7% being male. Median baseline creatinine was 1.7 (IQR 1.2-2.5) mg/dl, corresponding to an estimated glomerular filtration rate (eGFR) of 41.0 (IQR 25.2-62.2) ml/min/1.73 m2. In patients with acute kidney injury (AKI), 30-day mortality increased with AKI stages (no AKI 41.7%, AKI stage 1 43.3%, AKI stage 2 50.0%, AKI stage 3 63.7%; adjusted hazard ratio [HR] for AKI stage 3 1.97, 95% confidence interval [CI] 1.56-2.48, p < 0.001). Similarly, severe renal dysfunction (eGFR ≤ median) was associated with a 21% higher 30-day mortality risk (61.0% vs. 40.1%; adjusted HR 1.48, 95% CI 1.20-1.84, p < 0.001). Sepsis and bleeding were associated with both AKI and renal dysfunction, even after adjustment.

Conclusions: In HF-CS, kidney injury is associated with higher 30-day mortality, potentially mediated by bleeding and sepsis. These findings support the consideration of kidney function as a prognostic marker and call for the development and evaluation of kidney-restoring adjunct interventions in HF-CS.

Keywords: Cardiogenic shock; Heart failure; Kidney function; Kidney injury; Non‐AMI CS.

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References

    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599–3726. https://doi.org/10.1093/eurheartj/ehab368
    1. Naidu SS Baran DA Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, et al. SCAI SHOCK stage classification expert consensus update: A review and incorporation of validation studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol 2022 79 933 946 https://doi.org/10.1016/j.jacc.2022.01.018
    1. Van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation 2017;136:e232–e268. https://doi.org/10.1161/CIR.0000000000000525
    1. Osman M, Syed M, Patibandla S, Sulaiman S, Kheiri B, Shah MK, et al. Fifteen‐year trends in incidence of cardiogenic shock hospitalization and in‐hospital mortality in the United States. J Am Heart Assoc 2021;10:e021061. https://doi.org/10.1161/JAHA.121.021061
    1. Helgestad OKL, Josiassen J, Hassager C, Jensen LO, Holmvang L, Sørensen A, et al. Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: A Danish cohort study. Eur J Heart Fail 2019;21:1370–1378. https://doi.org/10.1002/ejhf.1566

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