SPC365

The Heart-Kidney Connection: Acute Kidney Injury in Cardiogenic Shock

Session: SESSÃO DE POSTERS 07 - DOENÇAS CARDIOVASCULARES - LESÃO RENAL AGUDA E INFLAMAÇÃO
Speaker: Rita Barbosa Sousa

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Cartazes
FP Number: ---
Authors: Rita Barbosa Sousa; Rui Gomes; C. Santos-Jorge; Rita Almeida Carvalho; Débora Sá; Miguel Sobral Domingues; Ana Rita Bello; João Presume; Catarina Brízido; Christopher Strong; Jorge Ferreira; António Tralhão
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">INTRODUCTION</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">Acute kidney injury (AKI) is a common complication in critically ill patients, with its impact on sepsis well-documented. In the setting of cardiogenic shock (CS), reduced renal perfusion and increased venous congestion, among other factors, may lead to varying degrees of renal dysfunction. However, its consequences remain insufficiently documented. We aimed to characterize the incidence and outcomes at hospitalization and at 1 year follow-up in patients with AKI associated with CS.</span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">METHODS</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">Single center retrospective analysis of consecutive patients admitted to a cardiac intensive care unit (CICU) between 2016 and 2023 with CS. &nbsp;AKI was defined by either KDIGO criteria based on serum creatinine (AKI-Cr) or urine output (AKI-UO) within 48 hours of admission. Time-to-event analysis evaluated all-cause mortality, with subgroups compared by Log-Rank test. Exclusion criteria were end-stage kidney disease, unknown prior renal status</span></span></span> <span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">and lack of data due to early death.</span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">RESULTS</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">A total of 262 patients were included (66 &plusmn;16 years, 66% males), with 23.3% (n=61) having previous chronic kidney disease (CKD). AKI occurred in 79.4% (n=208), with 73.7% (n=193) meeting AKI-Cr criteria. AKI-UO were available for 238 patients, of whom 60.1% (n=143) fulfilled criteria. Distribution of AKI stages is shown in Figure 1A. Continuous renal replacement therapy (CRRT) was required in 18.7% (n=49), primarily due to volume overload (n=41; 83.7%).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">Compared to patients without AKI, those with AKI, particularly those requiring CRRT (AKI-CRRT) were older (60 [47&ndash;68] vs. 70 [61&ndash;79] vs. 70 [50&ndash;82] years; p=0.001), more likely to have previous CKD (3.7% [n=2] vs. 24.0% [n=38] vs. 42.9% [n=21]; p&lt;0.001) and to require invasive mechanical ventilation (38.9% [n=21] vs. 60.4% [n=96] vs. 75.5% [n=37]; p&lt;0.001). No significant differences were found in mechanical circulatory support use, contrast volume administered or CICU length of stay. In-hospital mortality was significantly higher in patients with AKI and AKI-CRRT (24.1% [n=13] vs. 50.3% [n=80] vs. 61.2% [n=30]; p&lt;0.001). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">One-year mortality was 45.6% (n=140): 37.7% (n=20) without AKI, 56.2% (n=86) with AKI and 67.3% (n=33) with AKI-CRRT (p=0.007; Figure 1B), with 6 patients lost to follow-up. Both models showed similar discriminative power for this outcome (p=0.837), with C-statistics of 0.67 (95% CI: 0.61-0.73) for AKI-Cr and 0.67 (95% CI: 0.60-0.73) for AKI-UO.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">Among 116 patients who survived 1 year, 3 (2.6%) remained on chronic dialysis. Blood analyses were available for 97 survivors, of whom 81 (83.5%) recovered baseline renal function, while 16 (16.5%) experienced persistent reduction in renal function.</span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">CONCLUSION</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#071320">AKI is a highly prevalent condition in CS and is associated with both baseline clinical severity and worse outcomes. Among survivors, most recover their renal function during follow-up while a small fraction will require chronic dialysis. </span></span></span></span></span></p>