Introduction:
Acute kidney injury (AKI) is a common complication in heart failure (HF) patients and is associated with a poor prognosis. This study examined the renal outcomes of hospitalised HF patients. Variables that can predict the development of AKI and chronic kidney disease (CKD), the requirement of renal replacement therapy (RRT) and 90-day mortality were identified.
Methods:
Demographic and clinical data of patients hospitalised with a diagnosis of acute HF in University Malaya Medical Centre (UMMC) from January 2020 to June 2024 were extracted from the UMMC EMR database and analysed. Patients with CKD stage 5 (eGFR < 15 ml/min/1.73m2) were excluded from this study. The presence of AKI was documented and staged according to the KDIGO guideline. Among the cases that developed AKI, those that developed secondary outcomes (CKD, RRT and 90-day mortality) were identified. Univariate analyses and logistic regression were performed to identify the predictors for AKI and the respective secondary outcomes by SPSS version 29.0.
Results:
A total of 211 HF patients were included in this study, 86 of those patients developed AKI (40.76%). In the AKI group, 45 HF patients had CKD (eGFR < 60 ml/min/1.73m2) already at baseline. Within 90 days after hospitalisation, 5 patients developed new onset CKD (12.2%) in the AKI group, 2 patients required RRT (2.33%), and 12 patients died (13.95%) in the AKI group. The univariate analysis (Mann-Whitney U test, Chi-Square test or Fisher’s exact test) identified no significant predictors for progression to CKD. For RRT requirement, univariate analysis showed that systolic blood pressure (SBP) and mean arterial pressure (MAP) were significant predictors. However, the subsequent LR model showed that both were not significant predictors. Univariate analysis showed that the history of diabetes mellitus, ischemic heart disease (IHD), types of HF, CKD, SBP, diastolic blood pressure (DBP), MAP, heart rate (HR), presence of hypotensive episodes and requirement for inotropic support were the significant predictors for 90-day mortality. The optimised backward stepwise LR model identified IHD, MAP and the presence of hypotensive episodes as significant predictors of 90-day mortality.
Conclusions:
In this cohort study, various risk factors were associated with the RRT requirement and 90-day mortality in the hospitalised HF patients with AKI. This allows clinicians to identify the patients who would benefit from early intervention to improve patient outcomes.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.