Absence of Kidney Tubular Injury in Patients With Acute Heart Failure With Acute Kidney Injury.

IF 7.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Heart Failure Pub Date : 2024-11-01 Epub Date: 2024-10-18 DOI:10.1161/CIRCHEARTFAILURE.123.011751

Stephen Duff, Nicholas Wettersten, Yu Horiuchi, Dirk J van Veldhuisen, Sagar Raturi, Ruairi Irwin, Jean Maxime Côté, Alan Maisel, Joachim H Ix, Patrick T Murray

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Abstract

Background: Worsening renal function (WRF) is common in hospitalized patients being treated for acute heart failure. However, discriminating clinically significant WRF remains challenging. In patients hospitalized with acute heart failure, we evaluated if blood and urine biomarkers of cardiac and kidney dysfunction were associated with adverse outcomes.

Methods: We identified 175 of 927 participants in the AKINESIS study (Acute Kidney Neutrophil Gelatinase-Associated Lipocalin Evaluation of Symptomatic Heart Failure Study) who met criteria for stage 1 or 2 Kidney Disease: Improvement Global Outcomes acute kidney injury during the first 3 days of hospitalization. We measured 24 blood and urine biomarkers from specimens collected within 24 hours of meeting acute kidney injury criteria. The primary composite outcome consisted of worsening WRF (higher acute kidney injury stage), need for dialysis, or death at 30 days. Biomarkers' association with the composite outcome was assessed with logistic regression by tertiles and area under the curve (AUC).

Results: Of the 175 participants, 32 (18%) developed the primary composite outcome. Only history of chronic kidney disease was significantly different between those with and without the composite outcome. The highest tertile of plasma Gal-3 (galectin-3) and urine epidermal growth factor were associated with increased odds of the composite outcome compared with the lowest tertile in unadjusted analyses. After adjusting for serum creatinine, systolic blood pressure, and blood urea nitrogen, only the highest tertile of Gal-3 was associated with greater odds of the composite outcome (odds ratio, 4.6 [95% CI, 1.4-16.0). Gal-3 had the highest AUC (0.70 [95% CI, 0.58-0.82]), while epidermal growth factor had a lower AUC (0.63 [95% CI, 0.53-0.74]). Notably, urine biomarkers of kidney tubule injury were not associated with the composite outcome.

Conclusions: Tubular injury does not occur in most patients with acute heart failure experiencing WRF, consistent with the functional mechanisms of WRF in this patient population.

Registration: URL: https://www.clinicaltrials.gov/study/NCT01291836?term=NCT01291836&rank=1; Unique identifier: NCT01291836.

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急性心力衰竭合并急性肾损伤的患者无肾小管损伤。

背景：在接受急性心力衰竭治疗的住院患者中，肾功能恶化（WRF）很常见。然而，辨别具有临床意义的 WRF 仍然具有挑战性。在急性心力衰竭住院患者中，我们评估了血液和尿液中的心肾功能异常生物标志物是否与不良预后相关：我们从 AKINESIS 研究（急性肾脏中性粒细胞明胶酶相关脂质体评估无症状心力衰竭研究）的 927 名参与者中确定了 175 名符合肾脏疾病 1 期或 2 期标准的患者：住院头 3 天内急性肾损伤的标准。我们从符合急性肾损伤标准的 24 小时内采集的标本中测量了 24 种血液和尿液生物标记物。主要综合结果包括 WRF 恶化（急性肾损伤分期升高）、需要透析或 30 天后死亡。生物标志物与综合结果的关系通过三元组和曲线下面积（AUC）的逻辑回归进行评估：结果：在 175 名参与者中，32 人（18%）出现了主要的综合结果。只有慢性肾脏病史在出现和未出现综合结果的人群中存在显著差异。在未经调整的分析中，血浆Gal-3（galectin-3）和尿液表皮生长因子的最高三分位数与最低三分位数相比，与综合结果发生几率增加有关。在对血清肌酐、收缩压和血尿素氮进行调整后，只有 Gal-3 的最高三分位数与更高的综合结果几率相关（几率比为 4.6 [95% CI，1.4-16.0）。Gal-3的AUC最高（0.70 [95% CI, 0.58-0.82]），而表皮生长因子的AUC较低（0.63 [95% CI, 0.53-0.74]）。值得注意的是，肾小管损伤的尿液生物标志物与综合结果无关：结论：大多数急性心力衰竭患者在经历WRF后不会出现肾小管损伤，这与WRF在这一患者群体中的功能机制一致：URL: https://www.clinicaltrials.gov/study/NCT01291836?term=NCT01291836&rank=1; Unique identifier：NCT01291836。

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来源期刊

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.