scholarly journals MO407POSITIVE COMBINED BIOMARKER TEST IS AN INDEPENDENT PREDICTOR OF ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE CARDIAC DISEASES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marina Efremovtseva ◽  
Svetlana Avdoshina ◽  
Zhanna Kobalava
Keyword(s):  
Heart Failure ◽  
Early Diagnosis ◽  
Acute Decompensated Heart Failure ◽  
Simultaneous Detection ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Cardiac Diseases ◽  
Coronary Syndrome ◽  
Increased Risk

Abstract Background and Aims Biomarkers are currently considered as an additional criterion for the diagnosis of AKI. Early diagnosis of AKI is especially important in acute cardiovascular diseases due to increased risk of severe adverse events associated with development of cardiorenal syndrome. The aim of the study to explore the role of biomarkers in early diagnosis of AKI and their prognostic values in patients with acute cardiac diseases. Method 109 patients (51 with acute decompensated heart failure (ADHF), 58 with non-ST-elevation acute coronary syndrome (NSTE-ACS) were examined. Biomarkers of HF (NT-pro BNP in serum) and kidney damage (cystatin C in serum; neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and interleukine-18 (IL-18) in the urine) were estimated. Mann-Whitney test and multivariate logistic regression analysis were performed, p <0.05 was considered statistically significant. Results Patients with vs without AKI had higher levels of NGAL (344±308.8 vs 37.9±65.1 ng/ml, p <0.001) and KIM-1 (0.774±0.36 vs 0.402±0.59 ng/ml, p <0.01) in all groups. Patients with NSTE-ACS with vs without AKI had higher level of NT-proBNP (12857.1±3108.8 vs 10134±2479, p<0.001), no difference was detected in ADHF group. In course of ROC analyses NGAL and KIM-1 showed the best prognostic values (AUC value 0.948 and 0.760). The сut points for NGAL >60.1 ng/ml (sensitivity 87%, specificity 92%) and KIM-1 > 0.519 ng/ml (sensitivity 87%, specificity 67%) were detected, coefficient of association φ was 0,781 and 0,555 respectively. Simultaneous detection of two markers of structural kidney damage (increase of NGAL and/or KIM-1) in high-risk patients permits to diagnose 95% of AKI cases at admission. Patients with AKI and diagnostically significant levels of biomarkers had higher prevalence of CKD (p<0.01), acute heart failure, ADHF (p<0.05) vs those without increase of biomarkers, in-hospital mortality in this group was 29,8%. Conclusion Positive combined biomarker test is an independent and strong predictor of AKI in patients with acute cardiac diseases, and its implementation in clinical practice improve the early diagnostics of AKI when markers of kidney function are still at normal levels.

scholarly journals Risk assessment of acute kidney injury in patients with acute cardiovascular disease without invasive intervention

Kardiologiia ◽  
2020 ◽  
Vol 59 (12S) ◽  
pp. 46-56
Author(s):  
S. V. Avdoshina ◽  
M. A. Efremovtseva ◽  
S. V. Villevalde ◽  
Zh. D. Kobalava
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Acute Kidney Injury ◽  
Acute Decompensated Heart Failure ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Coronary Syndrome ◽  
Patients At Risk ◽  
Stage 1

Objective. To evaluate the prevalence, predictors, prognostic value of cardiorenal interrelations in patients with acute cardiovascular disease (CVD), and to develop an algorithm for stratification these patients at risk of acute kidney injury (AKI). Materials and methods. 566 patients (pts) were examined: 278 with acute decompensated heart failure (ADHF) and 288 with non-ST-elevation acute coronary syndrome (NSTE-ACS). The levels of electrolytes, glucose, urea, creatinine were evaluated, glomerular filtration rate (GFR) was determined according to the formula CKD-EPI. Chest x-ray, electrocardiography at admission and in dynamics, echocardiography at admission with assessment of systolic and diastolic myocardial functions were performed. Chronic kidney disease (CKD), AKI, ADHF, NSTE-ACS were diagnosed according to Russian and international Guidelines. Mann-Whitney test and multivariate logistic regression analysis were considered significant if p<0.05. Results. Different variants of cardiorenal interrelations were revealed in 366 (64.7%) pts. CKD was diagnosed in 259 (45.8%), with more than half of the cases (61%) diagnosed for the first time at this hospitalization, 62 (11%) pts had signs of kidney damage of unknown duration (which did not allow to diagnose CKD). AKI occurred in 228 (40,3%) pts, more frequently in patients with ADHF vs with NSTE-ACS (43.5 and 37.2%). In all groups stage 1 of AKI was prevalent. In-hospital mortality was significantly higher in pts with AKI vs without AKI (14.9 vs 3.6%, p<0.001). The risk of AKI was determined by kidney function and blood pressure levels at admission, and comorbidities. Conclusion. Prevalence of cardiorenal interactions in patients with acute CVD (ADHF and NSTE-ACS) was 64.7%. Development of AKI was associated with poor prognosis in both groups. Renal function and blood pressure levels on admission are the main predictors of AKI.

MO372IN-HOSPITAL MORTALITY IN ACUTE CARDIAC DISEASES IS ASSOСIATED WITH CERTAIN PHENOTYPES OF ACUTE KIDNEY INJURY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marina Efremovtseva ◽  
Svetlana Avdoshina ◽  
Zhanna Kobalava
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
De Novo ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Common Finding ◽  
Cardiac Diseases ◽  
Coronary Syndrome ◽  
Hospital Acquired ◽  
Transient Aki

Abstract Background and Aims Impaired renal function is a common finding in patients with cardiac diseases and confers an adverse prognosis in this population. To evaluate the incidence, phenotypes and prognostic value of cardiorenal interrelations in patients with acute decompensated heart failure (ADHF) and non-ST-elevation acute coronary syndrome (NSTE-ACS). Method we examined 278 patients with ADHF (85.3% had anamnesis of symptomatic HF with frequent hospitalizations, 20.1% had ejection fraction &lt;35%) and 288 with NSTE-ACS (64.9% developed myocardial infarction (MI)). In ADHF group in comparison with NSTE-ACS the patients were younger (69.7±10.2 vs 72±12.1 years, p&lt;0.01), there were more males (55.4 vs 36.5%, p&lt;0.001), smokers and alcohol abusers (47.8 and 30.6% vs 8 and 5.6%, p&lt;0.001). The comorbidities were more typical for ADHF group: atrial fibrillation 46 vs 24% (p&lt;0.001), obesity 55.8 vs 30.9% (p&lt;0.001), anemia 40.6 vs 25.3% (p&lt;0.001), diabetes mellitus 33.1 vs 23.3% (p&lt;0.01). Chronic kidney disease (CKD) and acute kidney injury (AKI) were diagnosed according to KDIGO 2012 Guidelines. AKI phenotypes were identified depending on time of development (community- or hospital-acquired), persistency (transient or persistent), history of CKD (AKI de novo or AKI on CKD). Results Incidence of CKD in patients with ADHF and NSTE-ACS was 45 and 46.5%, CKD was first diagnosed on admission in 57.6 and 64.2% of patients respectively. In 7.6% cases of ADHF and 14.2% of NSTE-ACS groups the duration of impaired kidney function was unknown. No associations of existing CKD and in-hospital mortality were detected. Incidence of AKI in ADHF and NSTE-ACS groups was 43.5 and 37.2%. The hospital-acquired AKI, AKI on CKD and persistent AKI were found in 52.9, 47.9 and 46.3% of ADHF patients, and in 57.9, 58.9 and 50.5% in NSTE-ACS group respectively. In-hospital mortality was higher in patients with AKI in ADHF and NSTE-ACS groups (12.4 vs 5%, p&lt;0.01 and 17.8 vs 3.3%, p&lt;0.001). Mortality in patients with ADHF and hospital-acquired persistent AKI de novo and community-acquired persistent AKI on CKD was 41 and 29%, and in community-acquired transient AKI on CKD in the NSTE-ACS group – 29%. Conclusion Different cardiorenal interrelations were revealed in 75.2% of patients with ADHF and in 61.8% with NSTE-ACS. In patients with acute cardiac diseases high in-hospital mortality is tightly associated with phenotypes of hospital-acquired persistent AKI de novo and community-acquired persistent AKI on CKD in ADHF, and in community-acquired transient AKI on CKD in the NSTE-ACS.

P4523Impact of comorbiditity on the predictive value of acute kidney injury in patients admitted for acute decompensated heart failure: a prospective study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Kayama ◽  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
S Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Absolute Increase ◽  
Increased Risk ◽  
Significant Difference ◽  
Comorbidity Burden ◽  
The Impact

Abstract Background Comorbidities are associated with poor clinical outcome in patients with chronic heart failure, and acute kidney injury (AKI) also provides prognostic information in patients with heart failure. However, there is no information available on the impact of comorbidities on the prognostic value of AKI in patients admitted for acute decompensated heart failure (ADHF). Methods We prospectively studied 357 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI) which is commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. AKI was defined as an absolute increase in serum creatinine of 0.3mg/dl or more during hospitalization. The endpoint was all-cause death (ACD). Results During a follow-up period of 2.2±1.4 years, 97 patients had ACD. At multivariate Cox analysis, ACCI (p<0.0001) and AKI (p=0.0061) were significantly and independently associated with ACD. Patients with high ACCI (≥5: determined by ROC analysis) had a significantly greater risk of ACD (39% vs 16%). In the subgroup of high ACCI, patients with AKI had a significantly higher risk of ACD (60% vs 35%), whereas there was no significant difference in the risk of ACD between with and without AKI (15% vs 16%) in the subgroup of low ACCI. Conclusions The presence of AKI was associated with the increased risk of mortality in ADHF patients with higher comorbidity burden but not in those without them.

scholarly journals Diagnostic and prognostic significance of aberrant miR-652-3p levels in patients with acute decompensated heart failure and acute kidney injury

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096782
Author(s):  
Jiaolei Liu ◽  
Hongmei Zhang ◽  
Xin Li ◽  
Lin Wang ◽  
Huining Yu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Early Diagnosis ◽  
Diagnostic Performance ◽  
Acute Decompensated Heart Failure ◽  
Characteristic Curve ◽  
Prognostic Significance ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Diagnostic Value

Objective This study aimed to examine a novel microRNA (miR-652-3p) biomarker to improve early diagnosis of acute kidney injury (AKI) in patients with acute decompensated heart failure (ADHF) and to evaluate the survival predictive value of miR-652-3p. Methods We retrospectively analyzed the data of 196 patients with ADHF, including 65 who developed AKI during hospitalization. Neutrophil gelatinase-associated lipocalin (NGAL) levels were measured in serum and urine samples. Real-time quantitative PCR was applied to evaluate miR-652-3p mRNA expression. The diagnostic performance of miR-652-3p was examined using receiver operating characteristic curve analysis. The prognostic value of miR-652-3p was also analyzed. Results Serum and urinary NGAL and miR-652-3p levels were elevated in patients with ADHF and AKI. Serum and urinary miR-652-3p expression had diagnostic value in predicting AKI onset in patients with ADHF, and it had improved diagnostic performance when used with NGAL. Patients with AKI and high miR-652-3p levels had a high failure rate of renal recovery and poor 180-day survival. Conclusion Serum and urinary miR-652-3p may be a candidate biomarker for early diagnosis of AKI in patients with ADHF and for predicting the prognosis of AKI. The combination of NGAL and miR-652-3p may accurately predict AKI onset in ADHF.

scholarly journals sCysC for early diagnosis of acute kidney injury in patients with acute decompensated heart failure

2018 ◽  
Vol 13 (3) ◽  
pp. 26
Author(s):  
M. V. Lediakhova ◽  
S. N. Nasonova ◽  
I. V. Zhirov ◽  
E. B. Yarovaya ◽  
T. M. Uskach ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Early Diagnosis ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure

scholarly journals Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

2021 ◽  
Vol 10 (10) ◽  
pp. 2151
Author(s):  
Rita Pavasini ◽  
Matteo Tebaldi ◽  
Giulia Bugani ◽  
Elisabetta Tonet ◽  
Roberta Campana ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Pooled Analysis ◽  
Coronary Syndrome ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Short Term Mortality

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

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