Predictors Of Death And Progression To CKD In Patients With Cardiorenal Syndrome

Background Acute kidney injury is very common in patients with heart failure,complicating 25%-51%of hospitalizations.Acute heart failure patients with AKI have longer hospital stays,higher readmission rates,higher long-term mortality,and also increased the risk of developing end-stage renal disease.About 20%-50%of survivors of AKI subsequently progress to CKD.This study is mainly aimed at analysing and finding the risk factors of CRS patients having poor clinical outcomes,which could help the clinician make a early intervention and treatment for the high-risk groups,we also collect the blood and urine sample of AKI patients in order to establish the basis for subsequent detection of biomarkers.Patients and methods This study is a prospective study,we enrolled patients with acute decompensated heart failure(ADHF)who were admitted to Guangdong General Hospital from April 2016 to January 2018.AKI was diagnosed according to the standard of 2012 KDIGO criteria.Exclusion criteria included the age younger than 18 years old,the hospitalized time was less than 24 hours,chronic kidney disease(CKD),the use of nephrotoxic drugs such as vancomycin and aminogiycosides antibiotics,urinary tract obstruction,malignant or infection,withd rawing treatment,undergoing cardiac surgery or angiography,renal artery stenosis,MODS.After the patients were enrolled,every patient was given a uniform number,and we recorded the clinical data of these patients as well as collected the blood and urine samples in order to detect the revelant biomarkers.Serum creatinine were obtained by regular outpatient or telephone follow-up of AKI survivors 3 months after AKI.The experimental data were analyzed by SPSS 23.0 statistical analysis software,and P(2-tailed)>0.05 was considered to be statistically significant.Results(1)Among 318 patients with ADHF,124 developed AKI,the incidence of AKI was 39.0%.After Removing five cases that were completely lost to follow-up,32 patients died within 3 months after AKI among 119 AKI patients,the mortality rate was 26.9%.Among 58 AKI survivors with a follow-up data of SCR,19 of them progressed to chronic kidney disease(CKD)after 3 months,the incidence of chronic kidney disease(CKD)progression is 32.8%.(2)HYHA Ⅳ(YES vs NO,Adjusted OR 3.642,95%CI 1.231-10.777,P=0.020),AKI2&3(YES vs NO,Adjusted OR 3.084,95%CI 1.173-8.113,P=0.022),dialysis(YES vs NO,Adjusted OR 3.763,95%CI 1.470-9.636,P=0.006)were independent predictors of death within 3 months after AKI.(3)Index eGFR,NT-proBNP,AKI2&3,dialysis were risk factors of the progression to CKD after AKI.(4)The AUC of clinical model to predict death of CRS patients is 0.806(P<0.001).Conclusions HYHA Ⅳ,AKI2&3 and dialysis were independent predictors of death within 3 months after AKI.Index eGFR,NT-proBNP,AKI2&3,dialysis were risk factors of the progression to CKD after AKI.