Impact of decreased serum albumin levels on acute kidney injury in patients with acute decompensated heart failure: a potential association of atrial natriuretic peptide.
Although hypoalbuminemia at admission is a risk for acute kidney injury (AKI) and mortality in patients with acute decompensated heart failure (ADHF), the clinical significance of decreased serum albumin levels (DAL) during ADHF therapy has not been elucidated. This study aimed to evaluate whether DAL was associated with AKI, and whether intravenous atrial natriuretic peptide (ANP) administration, which provides an effective treatment for ADHF but promotes albumin extravasation, was associated with DAL and AKI. A total of 231 consecutive patients with ADHF were enrolled. AKI was defined as ≥0.3 mg/dl absolute or 1.5-fold increase in serum creatinine levels within 48 h. AKI occurred in 73 (32%) of the 231 patients during ADHF therapy. The median value of decreases in serum albumin levels was 0.3 g/dl at 7 days after admission. When DAL was defined as ≥0.3 g/dl decrease in serum albumin levels, DAL occurred in 113 patients, and was independently associated with AKI. Of the 231 patients, 73 (32%) were treated with intravenous ANP. DAL occurred more frequently in patients receiving ANP than in those not receiving ANP (77 vs. 36%, p < 0.001), and ANP was independently associated with DAL. The incidence of AKI was higher in patients receiving ANP than in those not receiving ANP (48 vs. 24%, p < 0.001). ANP was independently associated with AKI. In conclusion, DAL is associated with AKI. Intravenous ANP administration may be one of the promoting factors of DAL, which leads to AKI, indicating a possible novel mechanism of AKI.
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Yoichi
Y
Takaya
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.
Fumiki
F
Yoshihara
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Hiroyuki
H
Yokoyama
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Hideaki
H
Kanzaki
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Masafumi
M
Kitakaze
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Yoichi
Y
Goto
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Toshihisa
T
Anzai
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Satoshi
S
Yasuda
Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Hisao
H
Ogawa
Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
Yuhei
Y
Kawano
Research Institute, National Cerebral and Cardiovascular Center, Suita, Japan.
Kenji
K
Kangawa
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000401:mortality; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D015994:Incidence; D007275:Injections, Intravenous; D007564:Japan / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate / Q000639:trends
D015415:Biomarkers; D012709:Serum Albumin; D009320:Atrial Natriuretic Factor; D003404:Creatinine
Acute decompensated heart failure; Acute kidney injury; Albumin; Atrial natriuretic peptide