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Impact of cardiorenal syndrome on outcomes in patients with acute heart failure (Master thesis)

Αλετράς, Γεώργιος/ Aletras, Georgios

Introduction: Acute cardiorenal syndrome (ACRS) encompasses a spectrum of disorders that induce acute kidney injury in the setting of acute heart failure (AHF). ACRS is associated with a poorer prognosis and presents significant therapeutic challenges. This study aimed to identify the most frequent comorbidities and clinical parameters associated with ACRS in hospitalized AHF patients and evaluate their impact on clinical outcomes. Methods: This retrospective observational study included patients hospitalized for AHF at the Venizeleio Cardiology Department between February and November 2023. Patients with incomplete data and end-stage CKD were excluded. Demographic characteristics, baseline comorbidities, chronic medications, laboratory and echocardiographic parameters at admission and during hospitalization, total hospital days, and in-hospital mortality were recorded. Survivors were followed for six months to assess changes in serum creatinine, emergency room visits, readmissions, need for renal replacement therapy, and mortality. ACRS was defined as an increase in serum creatinine by >0.3 mg/dL or >1.5 times the baseline value. Results: Of the 218 hospitalized AHF patients, 112 (51.4%) developed ACRS. Patients with ACRS were older, had a higher prevalence of CKD, and were more likely to present with advanced NYHA functional class and CKD stage. They also exhibited lower hemoglobin, baseline and admission estimated glomerular filtration rate (eGFR), and higher NT-proBNP levels. Multivariate analysis identified KDIGO CKD stage (OR 2.30, 95% CI 1.64-3.23, p<0.001) and the difference between the admission creatinine and the baseline value (OR 3.53, 95% CI 2.02-6.18, p<0.001) as independent risk factors for ACRS occurrence. ACRS emerged as a significant risk factor for adverse outcomes. It was associated with higher in-hospital mortality and emerged as an independent risk factor for mortality at six months. These patients also required more frequent vasoactive medications, had longer hospital stays, experienced more frequent worsening of renal function, had higher all-cause readmission rates at six months, and had more emergency department visits and a higher incidence of RRT requirement at three months. Conclusions: ACRS is a frequent complication among hospitalized AHF patients, with KDIGO CKD stage and the difference between the admission creatinine and the baseline value being independent predictors of its occurrence. The presence of ACRS is associated with significantly worse short- and mid-term outcomes, including increased mortality. Early identification of patients at risk for ACRS and individualized management strategies are crucial to improve prognosis in this high-risk population.