Prediction of acute kidney injury in patients with acute decompensated heart failure with Killip-Kimball class II.
K Badura, M Jozwik, A Baszkowski, M Nadel, A Misiewicz, J DrozdzAbstract
Background
Acute kidney injury (AKI) is a common complication among patients with acute decompensated heart failure (ADHF) and is known to be a strong predictor of mortality. While general predictors of AKI in ADHF patients are well described there is insufficient evidence focused on patients with mild acute heart failure symptoms but without overt shock or severe pulmonary oedema (Killip-Kimball class II).
Purpose
Our study aimed to identify predictors of AKI among patients with ADHF with Killip-Kimball class II to improve monitoring of patients at risk and modify potential factors contributing to AKI development. Additionally, we evaluated the prognostic value of AKI among this specific patient population.
Methods
This was a single-centre retrospective study which enrolled 172 consecutive patients hospitalized due to Killip-Kimball class II ADHF between January 2024 and August 2024. We analysed demographic data, medical history, comorbidities, baseline symptoms and electrocardiogram, transthoracic echocardiogram and laboratory test results during hospitalization. AKI was diagnosed as increase in serum creatinine of at least 0.3 mg/dL or 1.5-fold increase within 7 days. Patients with the history of nephrotoxic drug use, active malignancies and exposed to contrast media within the last 3 months were excluded from the study. Estimated glomerular filtration rate (eGFR) was based on serum creatinine using CKD-EPI formula.
Results
Among patients in Killip-Kimball class II ADHF following factors at baseline independently predicted AKI during in-hospital stay: glycated haemoglobin (HbA1c) (odds ratio [OR] 1.62 [95% confidence interval [95% CI]: 1.11-2.35], p=0.01), haemoglobin (Hb) (OR 0.71 [95% CI: 0.55-0.92], p=0.01), eGFR (OR 0.98 [95% CI 0.96-1.00], p=0.04) and New York Heart Association functional classification (NYHA) class II (OR 0.06 [95% CI 0.01-0.68], p=0.02). AKI was associated with prolonged in-hospital stay length (median: 5 vs. 7 days [interquartile range Q1-Q3 [IQR] 4-6 vs. 4-11 days] respectively, p<0.001) and higher peak N-terminal pro-B-type natriuretic peptide (NT-proBNP) (median: 3839 vs. 6907 pg/dL [IQR 2054-6865 vs. 2269-14100 pg/dL] respectively, p=0.004). AKI itself was not an independent predictor of in-hospital death (OR 7.35 [95% CI 0.82-66.19], p=0.08), however, at least stage 2 AKI independently predicted in-hospital death (OR 7.18 [95% CI 1.51-34.16), p=0.01). Moreover, AKI was an independent predictor of death after discharge (hazard ratio [HR] 2.08 [95% CI: 1.21-3.60], p=0.008).
Conclusion
AKI in patients hospitalized due to ADHF constitutes a frequent complication, associated with decreased survival. In our cohort however, only more severe stages of AKI (2 and 3) were independently associated with increased in-hospital mortality. Our study identified at least 3 potentially modifiable factors such as Hb, HbA1c and eGFR which were independently associated with AKI risk during ADHF hospitalization.Figure 1For image description, please refer to the figure legend and surrounding text.Figure 2For image description, please refer to the figure legend and surrounding text.