Prognostic value of acute kidney injury in patients hospitalized with acute decompensation of chronic heart failure

Aim. To study the effect of acute kidney injury in patients hospitalized with acute decompensation of chronic heart failure (ADCHF) in relation to combined renal and cardiovascular outcomes during 1 year of follow-up.
Materials and methods. A total of 108 patients hospitalized with ADCHF (mean age 68.3 ± 10.0 years, 60% men) were included in a single-center prospective study. All patients included in the study underwent a standard physical and laboratory instrumental examination, including an assessment of the clinical condition according to the Rating Scale of Clinical State (RSCS) and laboratory tests (including serum creatinine level, glomerular filtration rate (GFR) using the CKD-EPI 2021 equation, albumin to creatinine ratio in urine, natriuretic peptide (NT-proBNP) upon admission and discharge. Acute kidney injury (AKI) was diagnosed based on the KDIGO guidelines (Kidney Disease: Improving Global Outcomes). The total rate of all-cause mortality and repeated hospitalizations from ADCHF was evaluated as cardiovascular outcomes. Renal outcomes included deterioration of renal function in the form of a decrease in GFR >15% of baseline and a decrease in GFR < 30 ml/min/1.73 m2. Combined renal and cardiovascular outcomes were assessed during outpatient visits 3, 6, 12 months after discharge.
Results. The incidence of AKI during hospitalization in patients with ADCHF was 14% (n = 15). The groups with and without AKI were comparable in terms of clinical and demographic parameters and clinical assessment scale parameters. However, patients in the AKI group had higher baseline values of NT-proBNP and more pronounced impaired renal function, which persisted for 6–12 months of follow-up. There were no differences in clinical and laboratory data during the follow-up period. In patients with ADCHF, the presence of AKI during hospitalization significantly increases the risk of combined renal and cardiovascular outcomes during 1 year of follow-up (HR = 7.6; 95%CI = 2–29; p = 0.003).
Conclusion. The development of AKI during hospitalization in patients with ADCHF is a predictor of an unfavorable prognosis for combined renal and cardiovascular outcomes during 1 year of follow-up.

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