Heart Failure And Acute Kidney Injury

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Our current study demonstrates that among hospitalized HF patients, 2179 (32%) had traditional AKI (rise in serum creatinine by >=0.3 mg/dl) and 789 (12%) of hospitalized HF patients developed reverse AKI (drop in serum creatinine by >=0.3 mg/dl). The change in serum creatinine of greater than or equal to 0.3mg/dl was associated with higher 30-day all-cause readmission and mortality. Interestingly, reverse AKI group was also associated with higher 30-day all-cause readmission and mortality. To our knowledge this is the first study that reports 30-day all cause readmission and mortality by serial changes in serum creatinine in hospitalized HF patients. There is a need for increased awareness regarding this particular subset of patients.…show more content…
The explanation for presentation of this group is multifactorial including advanced stage of heart failure, old age, hypertension, diabetes mellitus, acute coronary syndrome, secondary to aggressive diuresis as supported by increased use of loop and potassium sparing diuretics and an intrinsic imbalance between the vasoconstrictive (epinephrine, angiotensin, endothelin) and vasodilatory hormones (natriuretic peptides, nitric oxide). 7 The risk of readmission and mortality in reverse AKI group is similar to traditional AKI as shown in our study. Hence the increase in creatinine is not only a marker of severity of heart failure but also represents a pathway for accelerated cardiovascular injury. In a study of chronic heart failure patients in ambulatory setting the authors found that worsening renal function within 6 months of referral was prognostically associated with all-cause mortality and heart failure readmission. 8 Major studies to date predicting heart failure morbidity and mortality do not include AKI as one of the prognostic indicators.9, 10 A recently published meta-analysis suggests that the benefit of renin-angiotensin aldosterone inhibitor is not diminished by worsening renal function and is in fact greater in the group with the worsening renal function.11 Hence contrary to the practice of stopping ACE/ARB in patients with AKI they are more essential in this high risk group with increased readmission and mortality. Also
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