| Peer-Reviewed

Prognostic Impact of Acute Kidney Injury on Decompensated Heart Failure

Received: 28 February 2021     Accepted: 22 March 2021     Published: 26 May 2021
Views:       Downloads:
Abstract

Decompensated heart failure (HF) is a complex and debilitating syndrome, which constitutes a severe emergency condition with high morbidity and mortality. Kidneys play fundamental roles in the pathophysiology of HF and, in the context of decompensations, acute kidney injury (AKI) has a bilateral cause-and-effect relationship, which can significantly worsen prognosis. However, the interaction between AKI and decompensated HF is poorly understood. This study aimed to assess the occurrence of AKI in patients hospitalized due to decompensated HF and to analyze its prognostic impact during hospitalization. This prospective single-center observational study included patients hospitalized due to decompensated HF in a tertiary-level teaching hospital, between July 2017 and January 2020. Patients who developed AKI during hospitalization were compared with those who did not develop it, until hospital discharge or death. AKI was defined as a serum creatinine increase greater than or equal to 0.3 mg/dl in 48 hours, a 1.5-fold increase in baseline creatinine in seven days or urinary volume <0.5 ml/kg/h for six hours, according to the Acute Kidney Injury Network (AKIN) criteria. The endpoints analyzed were death, need for invasive mechanical ventilation (IMV), and length of hospital stay. The Wilcoxon, Mann-Whitney and unpaired student t tests were used. Ninety-nine patients were included, with a mean age of 65.4±14 years, of which 47 (47.5%) were male and 52 (52.5%) were female. Reduced ejection fraction (EF) was observed in 77.8% of patients, whilst 22.2% had a diagnosis of HF with preserved EF. Decompensation clinical classifications were dry and warm=7 (7.1%), wet and warm=72 (72.7%), wet and cold=15 (15.1%) and dry and cold=5 (5.1%). The average left ventricular ejection fraction was 38.3%±15. AKI occurred in 22 patients (22.2%). Comparison between patients who evolved with and without AKI showed higher mortality (36.4% vs 10.4%, p=0.004) and need for IMV (54.5% vs 13%, p=0.0001) in the first group. There was no significant difference regarding the length of hospitalization (22.9±19 vs 18.8±16 days, p=0.26). Our results pointed to the occurrence of AKI was frequent in patients with decompensated HF requiring hospitalization, affecting approximately one out of five patients. This complication was significantly associated with increased mortality and the need for IMV during hospitalization.

Published in American Journal of Internal Medicine (Volume 9, Issue 3)
DOI 10.11648/j.ajim.20210903.13
Page(s) 121-126
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Heart Failure, Acute Kidney Injury, Prognosis, Mortality

References
[1] Comitê Coordenador da Diretriz de Insuficiência Cardíaca, Rohde, L., Montera, M. W., Bocchi, E. A., Clausell, N. O., Albuquerque, D. C., et al. (2018). Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda. Arquivos Brasileiros de Cardiologia, 111 (3), 436–539.
[2] Núñez, J., Miñana, G., Santas, E., & Bertomeu-González, V. (2015). Cardiorenal syndrome in acute heart failure: revisiting paradigms. Revista Española de Cardiologia (English Edition), 68 (5), 426-435.
[3] Ponikowski, P., Anker, S. D., AlHabib, K. F., Cowie, M. R., Force, T. L., Hu, S., et al. (2014). Heart failure: preventing disease and death worldwide. ESC heart failure, 1 (1), 4-25.
[4] Greenberg, B. (2012). Acute decompensated heart failure. Circulation Journal, 76 (3), 532-543.
[5] Health Ministry - Sistema de Informações Hospitalares do SUS. SIH/SUS. Available at: http://sihd.datasus.gov.br/principal/index.php.
[6] Ronco, C., Haapio, M., House, A. A., Anavekar, N., & Bellomo, R. (2008). Cardiorenal syndrome. Journal of the American College of Cardiology, 52 (19), 1527-1539.
[7] Ronco, C., Bellasi, A., & Di Lullo, L. (2019). Implication of Acute Kidney Injury in Heart Failure. Heart Failure Clinics, 15 (4), 463-476.
[8] Solomon, S. D., Dobson, J., Pocock, S., Skali, H., McMurray, J. J., Granger, C. B., & Pfeffer, M. A. (2007). Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation, 116 (13), 1482-7.
[9] Aronson, D., & Burger, A. J. (2010). The relationship between transient and persistent worsening renal function and mortality in patients with acute decompensated heart failure. Journal of Cardiac Failure, 16 (7), 541-547.
[10] de Bobadilla, J. F., & López-Sendón, J. (2009). Enfermedad renal: implicaciones terapéuticas en insuficiencia cardíaca y cardiopatía isquémica. Medicina Clínica, 132, 48-54.
[11] Dries, D. L., Exner, D. V., Domanski, M. J., Greenberg, B., & Stevenson, L. W. (2000). The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. Journal of the American College of Cardiology, 35 (3), 681-689.
[12] Goldberg, R. J., Ismailov, R. M., Patlolla, V., Lessard, D., & Spencer, F. A. (2008). Therapies for acute heart failure in patients with reduced kidney function: a community-based perspective. American Journal of Kidney Diseases, 51 (4), 594-602.
[13] Heywood, J. T., Fonarow, G. C., Costanzo, M. R., Mathur, V. S., Wigneswaran, J. R., Wynne, J., & ADHERE Scientific Advisory Committee and Investigators. (2007). High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. Journal of Cardiac Failure, 13 (6), 422-430.
[14] Stauffer, J. L., Olson, D. E., & Petty, T. L. (1981). Complications and consequences of endotracheal intubation and tracheotomy: a prospective study of 150 critically ill adult patients. The American Journal of Medicine, 70 (1), 65-76.
[15] Ponce, D., Zorzenon, C. D. P. F., Santos, N. Y. D., Teixeira, U. A., & Balbi, A. L. (2011). Acute kidney injury in intensive care unit patients: A prospective study on incidence, risk factors and mortality. Revista Brasileira de Terapia Intensiva, 23 (3), 321-326.
[16] Mebazaa, A., Tolppanen, H., Mueller, C., Lassus, J., DiSomma, S., Baksyte, G., et al. (2016). Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance. Intensive care medicine, 42 (2), 147-163.
[17] Garzotto, F., Piccinni, P., Cruz, D., Gramaticopolo, S., Dal Santo, M., Aneloni, G., et al. (2011). RIFLE-based data collection/management system applied to a prospective cohort multicenter Italian study on the epidemiology of acute kidney injury in the intensive care unit. Blood purification, 31 (1-3), 159-171.
[18] Peacock, W. F., Emerman, C., Costanzo, M. R., Diercks, D. B., Lopatin, M., & Fonarow, G. C. (2009). Early vasoactive drugs improve heart failure outcomes. Congestive Heart Failure, 15 (6), 256-264.
[19] Barbosa, R. R., Storch, T. S., Alves, F. B., Costa, V. S., Nascimento, C. C. R., Torres, L. D., et al. (2019). Hemoglobina e sódio séricos: marcadores prognósticos precoces na insuficiência cardíaca descompensada. Insuf. Card, 2-6.
[20] Reis, F. J. F. B. D., Fernandes, A. M. S., Bitencourt, A. G. V., Neves, F. B. C. S., Kuwano, A. Y., França, V. H. P., et al. (2009). Prevalence of anemia and renal insufficiency in non-hospitalized patients with heart failure. Arquivos Brasileiros de Cardiologia, 93 (3), 268-274.
[21] Sales, A. L. F., Villacorta, H., Reis, L., & Mesquita, E. T. (2005). Anemia as a prognostic factor in a population hospitalized due to decompensated heart failure. Arquivos Brasileiros de Cardiologia, 84 (3), 237-240.
[22] Peres, L. A. B., Cunha Júnior, A. D. D., Schäfer, A. J., Silva, A. L. D., Gaspar, A. D., Scarpari, D. F., et al. (2013). Biomarkers of acute kidney injury. Brazilian Journal of Nephrology, 35 (3), 229-236.
[23] Barros, L. C. N. D., Silveira, F. S., Silveira, M. S., Morais, T. C., Nunes, M. A. P., & Bastos, K. D. A. (2012). Insuficiência renal aguda em pacientes internados por insuficiência cardíaca descompensada-Reincade. Brazilian Journal of Nephrology, 34 (2), 122-129.
[24] Haase, M., Bellomo, R., Devarajan, P., Schlattmann, P., Haase-Fielitz, A., & Group, N. M. A. I. (2009). Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. American journal of kidney diseases, 54 (6), 1012-1024.
[25] Schiffl, H., & Lang, S. M. (2012). Update on biomarkers of acute kidney injury. Molecular diagnosis & therapy, 16 (4), 199-207.
Cite This Article
  • APA Style

    Layane Bonfante Batista, Roberto Ramos Barbosa, Caroline Feu Rosa Carrera, Gabriella Martins Curcio, Pietro Dall’Orto Lima, et al. (2021). Prognostic Impact of Acute Kidney Injury on Decompensated Heart Failure. American Journal of Internal Medicine, 9(3), 121-126. https://doi.org/10.11648/j.ajim.20210903.13

    Copy | Download

    ACS Style

    Layane Bonfante Batista; Roberto Ramos Barbosa; Caroline Feu Rosa Carrera; Gabriella Martins Curcio; Pietro Dall’Orto Lima, et al. Prognostic Impact of Acute Kidney Injury on Decompensated Heart Failure. Am. J. Intern. Med. 2021, 9(3), 121-126. doi: 10.11648/j.ajim.20210903.13

    Copy | Download

    AMA Style

    Layane Bonfante Batista, Roberto Ramos Barbosa, Caroline Feu Rosa Carrera, Gabriella Martins Curcio, Pietro Dall’Orto Lima, et al. Prognostic Impact of Acute Kidney Injury on Decompensated Heart Failure. Am J Intern Med. 2021;9(3):121-126. doi: 10.11648/j.ajim.20210903.13

    Copy | Download

  • @article{10.11648/j.ajim.20210903.13,
      author = {Layane Bonfante Batista and Roberto Ramos Barbosa and Caroline Feu Rosa Carrera and Gabriella Martins Curcio and Pietro Dall’Orto Lima and Vinicius Angelo Astolpho and Rodolfo Costa Sylvestre and Lucas Crespo De Barros and Renato Giestas Serpa and Osmar Araujo Calil and Luiz Fernando Machado Barbosa},
      title = {Prognostic Impact of Acute Kidney Injury on Decompensated Heart Failure},
      journal = {American Journal of Internal Medicine},
      volume = {9},
      number = {3},
      pages = {121-126},
      doi = {10.11648/j.ajim.20210903.13},
      url = {https://doi.org/10.11648/j.ajim.20210903.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210903.13},
      abstract = {Decompensated heart failure (HF) is a complex and debilitating syndrome, which constitutes a severe emergency condition with high morbidity and mortality. Kidneys play fundamental roles in the pathophysiology of HF and, in the context of decompensations, acute kidney injury (AKI) has a bilateral cause-and-effect relationship, which can significantly worsen prognosis. However, the interaction between AKI and decompensated HF is poorly understood. This study aimed to assess the occurrence of AKI in patients hospitalized due to decompensated HF and to analyze its prognostic impact during hospitalization. This prospective single-center observational study included patients hospitalized due to decompensated HF in a tertiary-level teaching hospital, between July 2017 and January 2020. Patients who developed AKI during hospitalization were compared with those who did not develop it, until hospital discharge or death. AKI was defined as a serum creatinine increase greater than or equal to 0.3 mg/dl in 48 hours, a 1.5-fold increase in baseline creatinine in seven days or urinary volume <0.5 ml/kg/h for six hours, according to the Acute Kidney Injury Network (AKIN) criteria. The endpoints analyzed were death, need for invasive mechanical ventilation (IMV), and length of hospital stay. The Wilcoxon, Mann-Whitney and unpaired student t tests were used. Ninety-nine patients were included, with a mean age of 65.4±14 years, of which 47 (47.5%) were male and 52 (52.5%) were female. Reduced ejection fraction (EF) was observed in 77.8% of patients, whilst 22.2% had a diagnosis of HF with preserved EF. Decompensation clinical classifications were dry and warm=7 (7.1%), wet and warm=72 (72.7%), wet and cold=15 (15.1%) and dry and cold=5 (5.1%). The average left ventricular ejection fraction was 38.3%±15. AKI occurred in 22 patients (22.2%). Comparison between patients who evolved with and without AKI showed higher mortality (36.4% vs 10.4%, p=0.004) and need for IMV (54.5% vs 13%, p=0.0001) in the first group. There was no significant difference regarding the length of hospitalization (22.9±19 vs 18.8±16 days, p=0.26). Our results pointed to the occurrence of AKI was frequent in patients with decompensated HF requiring hospitalization, affecting approximately one out of five patients. This complication was significantly associated with increased mortality and the need for IMV during hospitalization.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Prognostic Impact of Acute Kidney Injury on Decompensated Heart Failure
    AU  - Layane Bonfante Batista
    AU  - Roberto Ramos Barbosa
    AU  - Caroline Feu Rosa Carrera
    AU  - Gabriella Martins Curcio
    AU  - Pietro Dall’Orto Lima
    AU  - Vinicius Angelo Astolpho
    AU  - Rodolfo Costa Sylvestre
    AU  - Lucas Crespo De Barros
    AU  - Renato Giestas Serpa
    AU  - Osmar Araujo Calil
    AU  - Luiz Fernando Machado Barbosa
    Y1  - 2021/05/26
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajim.20210903.13
    DO  - 10.11648/j.ajim.20210903.13
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 121
    EP  - 126
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20210903.13
    AB  - Decompensated heart failure (HF) is a complex and debilitating syndrome, which constitutes a severe emergency condition with high morbidity and mortality. Kidneys play fundamental roles in the pathophysiology of HF and, in the context of decompensations, acute kidney injury (AKI) has a bilateral cause-and-effect relationship, which can significantly worsen prognosis. However, the interaction between AKI and decompensated HF is poorly understood. This study aimed to assess the occurrence of AKI in patients hospitalized due to decompensated HF and to analyze its prognostic impact during hospitalization. This prospective single-center observational study included patients hospitalized due to decompensated HF in a tertiary-level teaching hospital, between July 2017 and January 2020. Patients who developed AKI during hospitalization were compared with those who did not develop it, until hospital discharge or death. AKI was defined as a serum creatinine increase greater than or equal to 0.3 mg/dl in 48 hours, a 1.5-fold increase in baseline creatinine in seven days or urinary volume <0.5 ml/kg/h for six hours, according to the Acute Kidney Injury Network (AKIN) criteria. The endpoints analyzed were death, need for invasive mechanical ventilation (IMV), and length of hospital stay. The Wilcoxon, Mann-Whitney and unpaired student t tests were used. Ninety-nine patients were included, with a mean age of 65.4±14 years, of which 47 (47.5%) were male and 52 (52.5%) were female. Reduced ejection fraction (EF) was observed in 77.8% of patients, whilst 22.2% had a diagnosis of HF with preserved EF. Decompensation clinical classifications were dry and warm=7 (7.1%), wet and warm=72 (72.7%), wet and cold=15 (15.1%) and dry and cold=5 (5.1%). The average left ventricular ejection fraction was 38.3%±15. AKI occurred in 22 patients (22.2%). Comparison between patients who evolved with and without AKI showed higher mortality (36.4% vs 10.4%, p=0.004) and need for IMV (54.5% vs 13%, p=0.0001) in the first group. There was no significant difference regarding the length of hospitalization (22.9±19 vs 18.8±16 days, p=0.26). Our results pointed to the occurrence of AKI was frequent in patients with decompensated HF requiring hospitalization, affecting approximately one out of five patients. This complication was significantly associated with increased mortality and the need for IMV during hospitalization.
    VL  - 9
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Cardiology Department, Holy House of Mercy Medical School, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Medical School, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Medical School, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Medical School, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Hospital, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Hospital, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Hospital, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Hospital, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Medical School, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Medical School, Vitória, Brazil

  • Cardiology Department, Holy House of Mercy Medical School, Vitória, Brazil

  • Sections