Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: impact on outcomes

BMC Nephrology

Research Article

Pingyan Chen¹  Dingli Xu²  Jianping Bin²  Qiugen Zhou³  Xun Zhang³  Chunmei Zhao³  Min Liang³  Di Xie³  Fanfan Hou³ 

[1] Department of biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China;Division of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China;Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China;Guangdong Provincial Institute of Nephrology, Guangzhou, China;Key Lab for Organ Failure Research, Ministry of Education, Guangzhou, China;

关键词: Acute decompensated heart failure;    Acute kidney injury;    Acute-on-chronic kidney injury;    Outcome;   

DOI  :  10.1186/1471-2369-13-51

 received in 2011-11-06, accepted in 2012-07-02,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundAcute worsening of renal function, an independent risk factor for adverse outcomes in acute decompensated heart failure (ADHF), occurs as a consequence of new onset kidney injury (AKI) or acute deterioration of pre-existed chronic kidney disease (CKD) (acute-on-chronic kidney injury, ACKI). However, the possible difference in prognostic implication between AKI and ACKI has not been well established.MethodsWe studied all consecutive patients hospitalized with ADHF from 2003 through 2010 in Nanfang Hospital. We classified patients as with or without pre-existed CKD based on the mean estimated glomerular filtration rate (eGFR) over a six-month period before hospitalization. AKI and ACKI were defined by RIFLE criteria according to the increase of the index serum creatinine.ResultsA total of 1,005 patients were enrolled. The incidence of ACKI was higher than that of AKI. The proportion of patients with diuretic resistance was higher among patients with pre-existed CKD than among those without CKD (16.9% vs. 9.9%, P = 0.002). Compared with AKI, ACKI was associated with higher risk for in-hospital mortality, long hospital stay, and failure in renal function recovery. Pre-existed CKD and development of acute worsening of renal function during hospitalization were the independent risk factors for in-hospital death after adjustment by the other risk factors. The RIFLE classification predicted all-cause and cardiac mortality in both AKI and ACKI.ConclusionsPatients with ACKI were at greatest risk of adverse short-term outcomes in ADHF. Monitoring eGFR and identifying CKD should not be ignored in patients with cardiovascular disease.

【 授权许可】

Unknown   
© Zhou et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.