title: Impact of onset time of acute kidney injury on outcomes in patients with acute decompensated heart failure.
abstract: Since acute kidney injury (AKI) is not always related to mortality in patients with acute decompensated heart failure (ADHF), the aim of this study was to focus on onset time of AKI and its clinical importance. A total of 371 ADHF patients were included. The impact of AKI (≥ 0.3 mg/dl or 1.5-fold increase in serum creatinine level within 48 h) with early onset (≤ 4 days from admission) or late onset (≥ 5 days from admission) was assessed. AKI occurred in 99 patients, who were divided into two groups according to the median onset time of AKI: 50 with early onset of AKI and 49 with late onset of AKI. The maximum increase in serum creatinine level from admission was greater in patients with late onset of AKI than in patients with early onset of AKI (p = 0.012). Patients with late onset of AKI had a higher 12-month mortality rate than that in patients with early onset of AKI (log-rank test, p = 0.014). Late onset of AKI was an independent predictor of mortality (hazard ratio: 3.39, 95 % confidence interval: 1.84-6.18, p < 0.001). Late onset of AKI was associated with high blood urea nitrogen level at admission and intravenous administration of dobutamine. In conclusion, late onset of AKI related to high blood urea nitrogen level and intravenous administration of dobutamine, but not early onset of AKI, is linked to high mortality rate. Onset time of AKI may be useful for risk stratification of mortality in ADHF patients developing AKI.
authors.affiliation: Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaya
authors.affiliation: Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. fyoshi@hsp.ncvc.go.jp.
authors.forename: Fumiki
authors.initials: F
authors.lastname: Yoshihara
authors.affiliation: Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kanzaki
authors.affiliation: Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kitakaze
authors.affiliation: Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
authors.affiliation: Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kawano
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Acute decompensated heart failure; Acute kidney injury; Onset time; Prognosis