title: Predisposing factors for acute kidney injury in Hispanic patients treated with diuretics for decompensated heart failure.
abstract: OBJECTIVE
  In patients with congestive heart failure (CHF), use of loop diuretic therapy may result in acute kidney insufficiency (AKI). We assessed the factors that contributed to the development of AKI in patients with CHF treated with loop diuretics in a sample of patients who attended the Cardiovascular Center of Puerto Rico and the Caribbean (CCPRC).
  
  
  METHODS
  Medical records of 236 patients admitted between: January 1, 2008 to December 31, 2008 with the diagnosis of CHF were reviewed. Diagnosis of CHF based on symptoms and signs was confirmed by echocardiography. Twenty six (26) patients with significant valvular disease and four (4) patients who did not receive diuretics during hospitalization were excluded. Hospital course was observed until diuretic therapy was discontinued or patient was discharged. AKI was defined as a 25% increase in serum creatinine level after the start of diuretic therapy. The study sample was categorized in two groups: patients who developed AKI and those who did not. Variables associated with AKI (p<0.05) in the bivariate logistic regression models were included in the multivariate logistic regression models.
  
  
  RESULTS
  In the multivariate logistic regression model, only a greater dose of diuretic therapy (>80 mg/dl) and history of diabetes mellitus were significantly (p<0.05) associated with AKI.
  
  
  CONCLUSIONS
  Analysis of data shows that increased doses of diuretic therapy and history of diabetes mellitus were significantly associated with AKI in patients with CHF. This study highlights the importance of monitoring the doses of diuretic therapy during hospitalization, in this group of patients.
authors.affiliation: Cardiology Section, Internal Medicine Department, School of Medicine, University of Puerto Rico Medical Science Campus, San Juan, Puerto Rico.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ricci
authors.forename: Tania
authors.initials: T
authors.lastname: Ramírez
authors.forename: Rossella
authors.initials: R
authors.lastname: Marmorato
authors.forename: José
authors.initials: J
authors.lastname: Vega
authors.forename: Pedro
authors.initials: P
authors.lastname: Pagán
authors.forename: José E
authors.initials: JE
authors.lastname: López
authors.forename: Marievelisse
authors.initials: M
authors.lastname: Soto-Salgado
authors.forename: José L
authors.initials: JL
authors.lastname: Cangiano
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D004363:Drug Utilization; D004487:Edema / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005665:Furosemide / Q000009:adverse effects / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006753:Hospital Records; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D009765:Obesity / Q000453:epidemiology; D011647:Puerto Rico / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013148:Spironolactone / Q000627:therapeutic use
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D049994:Sodium Potassium Chloride Symporter Inhibitors; D013148:Spironolactone; D005665:Furosemide; D003404:Creatinine