Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure
INTRODUCTION Hospitalization for acute decompensation of heart failure (ADHF) is a frequent event associated with long-term adverse effects. Prognosis is even worse if acute kidney injury (AKI) occurs during hospitalization.OBJECTIVES The study aimed to determine whether kidney damage biomarkers neu...
| Autores: | , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/191813 |
| Acceso en línea: | https://hdl.handle.net/2445/191813 |
| Access Level: | acceso abierto |
| Palabra clave: | Insuficiència renal aguda Insuficiencia cardíaca Acute renal failure Heart failure |
| Sumario: | INTRODUCTION Hospitalization for acute decompensation of heart failure (ADHF) is a frequent event associated with long-term adverse effects. Prognosis is even worse if acute kidney injury (AKI) occurs during hospitalization.OBJECTIVES The study aimed to determine whether kidney damage biomarkers neutrophil gelatinase--associatedlipocalin (NGAL), kidney injury molecule 1 (KIM-1), and interleukin 18 (IL-18) might predict AKI and have prognostic value in ADHF.PATIENTS AND METHODS Serum NGAL on admission and urine NGAL, KIM-1, and IL-18 on discharge were determined in 187 ADHF patients enrolled in a prospective, observational, unblinded study. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. Patients were followed for 12 months to record all-cause mortality.RESULTS A total of 22% patients died during the follow-up, with 52.5% dying within 4 months after discharge. Serum NGAL (P <0.001), urine NGAL (P = 0.047), and urinary KIM-1 (P = 0.014) levels were significantly higher in the deceased patients at discharge. After adjustment for estimated glomerular filtration rate (eGFR), only urinary KIM-1 independently predicted mortality at month 4 (hazard ratio [HR], 3.166; 95% CI, 1.203-8.334; P = 0.020) and month 12 (HR, 1.969; 95% CI, 1.123-3.454; P = 0.018) in Cox regression models. In receiver operating characteristic (ROC) analysis urinary KIM-1 (area under the ROC curve [AUC] = 0.830) outperformed other markers of renal function. The Kaplan-Meier sur-vival analysis showed KIM-1 predictive value as additive to that of AKI incidence and admission eGFR. Admission serum NGAL was higher in AKI patients (P <= 0.001) with a modest diagnostic performance (AUC = 0.667), below that of urea (AUC = 0.732), creatinine (AUC = 0.696), or cystatin C (AUC = 0.676).CONCLUSIONS Discharge urinary KIM-1 was a strong and independent predictor of mortality, particularly during the most vulnerable period shortly after hospitalization. Admission serum NGAL was inferior to conventional renal function parameters in predicting AKI during ADHF. |
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