Highlights
- •Pre-hospital renal function levels improve acute kidney injury identification.
- •Acute kidney injury is already present at admission in a large number of patients.
- •Worse clinical outcomes are associated with pre-hospital renal function.
- •Acute kidney injury at admission identifies patients with worse prognosis.
Abstract
Background
Acute kidney injury (AKI) is a serious complication in patients hospitalized for decompensated
heart failure (HF). Currently, AKI definitions consider creatinine levels at admission
as reference of baseline renal function (RF). However, renal impairment may already
be present at admission. We aimed to study the impact on AKI detection of considering
outpatient RF as reference.
Methods
In a cohort of 458 patients hospitalized for decompensated HF, we studied the occurrence
of AKI using the standardized KDIGO criteria and grading (stages: 1, 2, 3), and considering
two different definitions according to the RF used as reference or baseline: the latest
outpatient measurement prior to admission vs. the first measurement at admission.
We compared the prevalence, timing and prognostic value for both AKI definitions.
Results
The definition based on outpatient RF was associated with an increase in overall AKI
detection from 20.1% to 33.8% (p < 0.001), and from 3.1% to 5.0% for advanced stages (2–3) (p < 0.001); additionally, 12.5% of patients already had criteria of AKI at admission
(36.8% of AKI cases). Both definitions were associated with longer hospital stay.
However, only AKI already present at admission, as based on pre-hospital creatinine,
was independently associated with all-cause death, in-hospital and after discharge,
and death or HF readmission in the follow-up: 1 stage (HR 2.72, 95%CI 1.83–4.06, p < 0.001) and 2–3 stage (HR 7.29, 95%CI, 3.02–17.64, p < 0.001).
Conclusions
Evaluation of AKI in patients admitted with HF should consider pre-hospital RF, since
it improves early identification of AKI and has implications for risk assessment.
Keywords
Abbreviations:
HF (Heart Failure), RF (Renal function), AKI (Acute kidney injury), Cr (Serum creatinine), GFRe (Estimated glomerular filtration rate), CKD (Chronic kidney disease)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 29, 2020
Accepted:
February 24,
2020
Received in revised form:
February 6,
2020
Received:
August 25,
2019
Identification
Copyright
© 2020 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
