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Acute kidney injury in heart failure: a population study

AIMS: The objective of the present study is to assess the prognostic value of acute kidney injury (AKI) in the evolution of patients with heart failure (HF) using real‐world data. METHODS AND RESULTS: Patients with a diagnosis of HF and with serial measurements of renal function collected throughout...

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Autores principales: Holgado, Jose Luis, Lopez, Cristina, Fernandez, Antonio, Sauri, Inmaculada, Uso, Ruth, Trillo, Jose Luis, Vela, Sara, Nuñez, Julio, Redon, Josep, Ruiz, Adrian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160477/
https://www.ncbi.nlm.nih.gov/pubmed/32059081
http://dx.doi.org/10.1002/ehf2.12595
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author Holgado, Jose Luis
Lopez, Cristina
Fernandez, Antonio
Sauri, Inmaculada
Uso, Ruth
Trillo, Jose Luis
Vela, Sara
Nuñez, Julio
Redon, Josep
Ruiz, Adrian
author_facet Holgado, Jose Luis
Lopez, Cristina
Fernandez, Antonio
Sauri, Inmaculada
Uso, Ruth
Trillo, Jose Luis
Vela, Sara
Nuñez, Julio
Redon, Josep
Ruiz, Adrian
author_sort Holgado, Jose Luis
collection PubMed
description AIMS: The objective of the present study is to assess the prognostic value of acute kidney injury (AKI) in the evolution of patients with heart failure (HF) using real‐world data. METHODS AND RESULTS: Patients with a diagnosis of HF and with serial measurements of renal function collected throughout the study period were included. Estimated glomerular filtration rate (GFR) was calculated with the CKD‐EPI (Chronic Kidney Disease Epidemiology Collaboration). AKI was defined when a sudden drop in creatinine with posterior recovery was recorded. According to the Risk, Injury, Failure, Loss, and End‐Stage Renal Disease (RIFLE) scale, AKI severity was graded in three categories: risk [1.5‐fold increase in serum creatinine (sCr)], injury (2.0‐fold increase in sCr), and failure (3.0‐fold increase in sCr or sCr > 4.0 mg/dL). AKI incidence and risk of hospitalization and mortality after the first episode were calculated by adjusting for potential confounders. A total of 30 529 patients with HF were included. During an average follow‐up of 3.2 years, 5294 AKI episodes in 3970 patients (13.0%) and incidence of 3.3/100 HF patients/year were recorded. One episode was observed in 3161 (10.4%), two in 537 (1.8%), and three or more in 272 (0.9%). They were more frequent in women with diabetes and hypertension. The incidence increases across the GFR levels (Stages 1 to 4: risk 7.6%, 6.8%, 11.3%, and 12.5%; injury 2.1%, 2.0%, 3.3%, and 5.5%; and failure 0.9%, 0.6%. 1.4%, and 8.0%). A total of 3817 patients with acute HF admission were recorded during the follow‐up, with incidence of 38.4/100 HF patients/year, 3101 (81.2%) patients without AKI, 545 (14.3%) patients with one episode, and 171 (4.5%) patients with two or more. The number of AKI episodes [one hazard ratio (HR) 1.05 (0.98–1.13); two or more HR 2.01 (1.79–2.25)] and severity [risk HR 1.05 (0.97–1.04); injury HR 1.41 (1.24–1.60); and failure HR 1.90 (1.64–2.20)] increases the risk of hospitalization. A total of 10 560 deaths were recorded, with incidence of 9.3/100 HF patients/year, 8951 (33.7%) of subjects without AKI episodes, 1180 (11.17%) of subjects with one episode, and 429 (4.06%) with two or more episodes. The number of episodes [one HR 1.05 (0.98–1.13); two or more HR 2.01 (1.79–2.25)] and severity [risk 1.05 confidence interval (CI) (0.97–1.14), injury 1.41 (CI 1.24–1.60), and failure 1.90 (CI 1.64–2.20)] increases mortality risk. CONCLUSIONS: The study demonstrated the worse prognostic value of sudden renal function decline in HF patients and pointed to those with more future risk who require review of treatment and closer follow‐up.
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spelling pubmed-71604772020-04-20 Acute kidney injury in heart failure: a population study Holgado, Jose Luis Lopez, Cristina Fernandez, Antonio Sauri, Inmaculada Uso, Ruth Trillo, Jose Luis Vela, Sara Nuñez, Julio Redon, Josep Ruiz, Adrian ESC Heart Fail Original Research Articles AIMS: The objective of the present study is to assess the prognostic value of acute kidney injury (AKI) in the evolution of patients with heart failure (HF) using real‐world data. METHODS AND RESULTS: Patients with a diagnosis of HF and with serial measurements of renal function collected throughout the study period were included. Estimated glomerular filtration rate (GFR) was calculated with the CKD‐EPI (Chronic Kidney Disease Epidemiology Collaboration). AKI was defined when a sudden drop in creatinine with posterior recovery was recorded. According to the Risk, Injury, Failure, Loss, and End‐Stage Renal Disease (RIFLE) scale, AKI severity was graded in three categories: risk [1.5‐fold increase in serum creatinine (sCr)], injury (2.0‐fold increase in sCr), and failure (3.0‐fold increase in sCr or sCr > 4.0 mg/dL). AKI incidence and risk of hospitalization and mortality after the first episode were calculated by adjusting for potential confounders. A total of 30 529 patients with HF were included. During an average follow‐up of 3.2 years, 5294 AKI episodes in 3970 patients (13.0%) and incidence of 3.3/100 HF patients/year were recorded. One episode was observed in 3161 (10.4%), two in 537 (1.8%), and three or more in 272 (0.9%). They were more frequent in women with diabetes and hypertension. The incidence increases across the GFR levels (Stages 1 to 4: risk 7.6%, 6.8%, 11.3%, and 12.5%; injury 2.1%, 2.0%, 3.3%, and 5.5%; and failure 0.9%, 0.6%. 1.4%, and 8.0%). A total of 3817 patients with acute HF admission were recorded during the follow‐up, with incidence of 38.4/100 HF patients/year, 3101 (81.2%) patients without AKI, 545 (14.3%) patients with one episode, and 171 (4.5%) patients with two or more. The number of AKI episodes [one hazard ratio (HR) 1.05 (0.98–1.13); two or more HR 2.01 (1.79–2.25)] and severity [risk HR 1.05 (0.97–1.04); injury HR 1.41 (1.24–1.60); and failure HR 1.90 (1.64–2.20)] increases the risk of hospitalization. A total of 10 560 deaths were recorded, with incidence of 9.3/100 HF patients/year, 8951 (33.7%) of subjects without AKI episodes, 1180 (11.17%) of subjects with one episode, and 429 (4.06%) with two or more episodes. The number of episodes [one HR 1.05 (0.98–1.13); two or more HR 2.01 (1.79–2.25)] and severity [risk 1.05 confidence interval (CI) (0.97–1.14), injury 1.41 (CI 1.24–1.60), and failure 1.90 (CI 1.64–2.20)] increases mortality risk. CONCLUSIONS: The study demonstrated the worse prognostic value of sudden renal function decline in HF patients and pointed to those with more future risk who require review of treatment and closer follow‐up. John Wiley and Sons Inc. 2020-02-14 /pmc/articles/PMC7160477/ /pubmed/32059081 http://dx.doi.org/10.1002/ehf2.12595 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research Articles
Holgado, Jose Luis
Lopez, Cristina
Fernandez, Antonio
Sauri, Inmaculada
Uso, Ruth
Trillo, Jose Luis
Vela, Sara
Nuñez, Julio
Redon, Josep
Ruiz, Adrian
Acute kidney injury in heart failure: a population study
title Acute kidney injury in heart failure: a population study
title_full Acute kidney injury in heart failure: a population study
title_fullStr Acute kidney injury in heart failure: a population study
title_full_unstemmed Acute kidney injury in heart failure: a population study
title_short Acute kidney injury in heart failure: a population study
title_sort acute kidney injury in heart failure: a population study
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160477/
https://www.ncbi.nlm.nih.gov/pubmed/32059081
http://dx.doi.org/10.1002/ehf2.12595
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