PROGNOSTIC VALUE OF KIDNEY ACUTE INJURY EPISODES IN HEART FAILURE

Objective: Renal function is an important prognostic factor in patients with Heart Failure (HF) and chronic kidney disease (CKD) has been associated to worse prognosis, however the impact of episodes of Acute Kidney Injury (AKI) has not been analyzed. The objective of the present is to analyze in HF patients the prognostic value of AKI in the mortality risk. Design and method: Patients with diagnosis of HF from the EHR of the Valencia Community with follow-up in renal function parameters were included (45.3% males, mean age 75.6 yr). eGFR was calculated with the CKD-EPI formula. Repeated values of renal function were available during an average of 2.5 years and CKD stages were those defined by Q-DIGO at the beginning of the study period. AKI was defined by two criteria: a) sudden increment of 30% in serum creatinine with posterior recovery; b) sudden decrease of 30% in eGFR with posterior recovery. All cause of mortality was obtained from the legal registry. The risk for mortality for the number of episodes of AKI were assessed by Cox proportional hazard model adjusted by potential confounders age, sex, HTN, DM and CKD stage. Results: A total of 34054 patients (55% females, mean age 75.6 yr) were included. As relevant comorbidities were hypertension 81%, and diabetes mellitus 44%. CKD stages were 1 and 2 19244 patients, stage 3 12320 and stage 4 2440. No subjects in stage 5 were included. The number of AKI episodes by creatinine criteria were 3047, 1 episode 2879, and two or more 168. By eGFR were 12197, 10055 one episode and 2142 two or more. A total of 13411 deaths were registered. The AKI HRs according the two criteria are in the table:Conclusions: Episodes of AKI assessed by changes in serum creatinine are an independent prognostic marker in subjects with HF independent of the CKD stage.