Beyond a passing decline: acute cardiorenal syndrome as a marker of true renal dysfunction

Le résumé fourni par la source

Abstract Introduction Acute cardiorenal syndrome (ACRS) is a common complication in acute heart failure (AHF) and has been linked to worse outcomes. However, some cases of worsening renal function (WRF) may reflect hemodynamic shifts rather than true kidney injury. Purpose This study aims to investigate whether ACRS is associated with more advanced kidney disease and poorer prognosis, using six-month surveillance and renal function reassessment to differentiate between transient and progressive renal dysfunction. Materials-Methods This prospective observational study included patients hospitalized for AHF at a cardiology department between February 2023 and September 2024. Patients with incomplete data and end-stage CKD were excluded. Demographic characteristics, baseline comorbidities, chronic medications, laboratory and echocardiographic parameters at admission and during hospitalization, total hospital days, and in-hospital mortality were recorded. Survivors were followed for six months to assess changes in serum creatinine, readmissions, need for renal replacement therapy (RRT) and mortality. ACRS was defined as an increase in serum creatinine by >0.3 mg/dL or >1.5 times the baseline value. Six-month mortality and RRT requirement were considered primary endpoints, while changes in renal function and readmission rates were secondary endpoints. Results Of the 330 hospitalized AHF patients, 166 (50.3%) developed ACRS. Patients with ACRS were older, had a higher prevalence of CKD and were more likely to present with advanced NYHA functional class and CKD stage. They also exhibited lower Hb levels, lower baseline and admission eGFR and higher NT-proBNP levels. Furosemide use was significantly associated with ACRS. Multivariate analysis including all the parameters above identified eGFR (OR 0.971, 95% CI 0.954-0.988, p<0.001) and urea levels (OR 1.016, 95% CI 1.004-1.028, p=0.01) on admission as independent risk factors for ACRS occurrence. ACRS emerged as a significant risk factor for adverse outcomes. It was associated with higher in-hospital and six-month mortality, while these patients also required more frequent vasoactive medications, had longer hospital stays, experienced more frequent WRF, had higher all-cause readmission rates at six months and a higher incidence of RRT requirement at six months. Conclusions ACRS occurred in half of the AHF patients and was strongly associated with worse baseline kidney function, higher NT-proBNP levels and more advanced NYHA class and CKD stage at presentation. Independent predictors of ACRS were admission eGFR and urea levels, suggesting that its occurrence is primarily kidney-driven rather than heart-driven. ACRS was linked to increased in-hospital and six-month mortality, longer hospital stays, higher readmission rates and greater need for RRT. These findings highlight the prognostic significance of ACRS and the need for careful renal function monitoring in AHF management.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.