Khaled Abdel-Kader
Last active: 11/29/2018

Acute Kidney Injury and Risk of Incident Heart Failure Among US Veterans.

Bansal N, Matheny ME, Greevy RA, Eden SK, Perkins AM, Parr SK, Fly J, Abdel-Kader K, Himmelfarb J, Hung AM, Speroff T, Ikizler TA, Siew ED
Am J Kidney Dis. 2018 71 (2): 236-245

PMID: 29162339 · DOI:10.1053/j.ajkd.2017.08.027

BACKGROUND - Acute kidney injury (AKI) is common and associated with poor outcomes. Heart failure is a leading cause of cardiovascular disease among patients with chronic kidney disease. The relationship between AKI and heart failure remains unknown and may identify a novel mechanistic link between kidney and cardiovascular disease.

STUDY DESIGN - Observational study.

SETTING & PARTICIPANTS - We studied a national cohort of 300,868 hospitalized US veterans (2004-2011) without a history of heart failure.

PREDICTOR - AKI was the predictor and was defined as a 0.3-mg/dL or 50% increase in serum creatinine concentration from baseline to the peak hospital value. Patients with and without AKI were matched (1:1) on 28 in- and outpatient covariates using optimal Mahalanobis distance matching.

OUTCOMES - Incident heart failure was defined as 1 or more hospitalization or 2 or more outpatient visits with a diagnosis of heart failure within 2 years through 2013.

RESULTS - There were 150,434 matched pairs in the study. Patients with and without AKI during the index hospitalization were well matched, with a median preadmission estimated glomerular filtration rate of 69mL/min/1.73m. The overall incidence rate of heart failure was 27.8 (95% CI, 19.3-39.9) per 1,000 person-years. The incidence rate was higher in those with compared with those without AKI: 30.8 (95% CI, 21.8-43.5) and 24.9 (95% CI, 16.9-36.5) per 1,000 person-years, respectively. In multivariable models, AKI was associated with 23% increased risk for incident heart failure (HR, 1.23; 95% CI, 1.19-1.27).

LIMITATIONS - Study population was primarily men, reflecting patients seen at Veterans Affairs hospitals.

CONCLUSIONS - AKI is an independent risk factor for incident heart failure. Future studies to identify underlying mechanisms and modifiable risk factors are needed.

Copyright © 2017 National Kidney Foundation, Inc. All rights reserved.

MeSH Terms (20)

Acute Kidney Injury Aged Cardiovascular Diseases Cohort Studies Creatinine Disease Progression Female Glomerular Filtration Rate Heart Failure Hospitalization Humans Incidence Kidney Male Middle Aged Renal Insufficiency, Chronic Retrospective Studies Risk Factors United States Veterans

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