Markers of renal function and acute kidney injury in acute heart failure: definitions and impact on outcomes of the cardiorenal syndrome
- 27 August 2010
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 31 (22), 2791-2798
- https://doi.org/10.1093/eurheartj/ehq293
Abstract
Aims Acute kidney injury (AKI) in patients hospitalized for acute heart failure (AHF) is part of the cardiorenal syndrome and has been associated with increased morbidity and mortality. However, definitions and prognostic impact of AKI in AHF have been variable. Cystatin C is a prospective new marker of AKI. The objective of this study was to investigate the use of cystatin C as a marker of early AKI in AHF. Methods and results Patients (n = 292) hospitalized for AHF had measurements of cystatin C on admission and at 48 h. We assessed the incidence of a rise in cystatin C between the two measurements and evaluated the effect of an increase in cystatin C on outcomes up to 12 months. The population was on average 75 years old and 49% were female. On admission, median cystatin C was 1.25 mg/L (interquartile range 0.99–1.61 mg/L). A rise in cystatin C by >0.3 mg/L within 48 h after hospitalization (AKIcysC) occurred in 16% of patients and resulted in 3 days (P = 0.01) longer hospital stay and was associated with significantly higher in-hospital mortality, odds ratio 4.0 [95% confidence intervals (CI) 1.3–11.7, P = 0.01]. During follow-up, AKIcysC was an independent predictor of 90 days mortality, adjusted odds ratio 2.8 (95% CI 1.2–6.7, P = 0.02). Conclusion Cystatin C appears to be a useful marker of early AKI in patients hospitalized for AHF. A decline in renal function detected by cystatin C during the first 48 h after hospitalization occurs frequently in AHF and has a detrimental impact on prognosis.Keywords
This publication has 32 references indexed in Scilit:
- Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality InitiativeEuropean Heart Journal, 2009
- Cystatin C in Acute Heart Failure Without Advanced Renal ImpairmentAmerican Journal Of Medicine, 2009
- Cardiorenal SyndromeJournal of the American College of Cardiology, 2008
- ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)European Heart Journal, 2008
- Worsening Renal Function and Prognosis in Heart Failure: Systematic Review and Meta-AnalysisJournal of Cardiac Failure, 2007
- Prognostic value of cystatin C in acute heart failure in relation to other markers of renal function and NT-proBNPEuropean Heart Journal, 2007
- Amino-Terminal Pro-Brain Natriuretic Peptide, Renal Function, and Outcomes in Acute Heart Failure: Redefining the Cardiorenal Interaction?Journal of the American College of Cardiology, 2006
- Renal Impairment and Outcomes in Heart FailureJournal of the American College of Cardiology, 2006
- Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of CardiologyEuropean Heart Journal, 2005
- Correlates and impact on outcomes of worsening renal function in patients ≥65 years of age with heart failureThe American Journal of Cardiology, 2000