Clinically Significant High-Grade AV Block as a Reversible Cause for Acute Kidney Injury in Hospitalized Patients-A Propensity Score Matched Cohort.

Aviram Hochstadt,Aviram Hochstadt,Yoav Granot,Yoav Granot,Ilan Merdler,Ilan Merdler,Maayan Konigstein,Maayan Konigstein,Raphael Rosso,Ido Avivi,Merav Ingbir,Merav Ingbir,Ido Avivi,Sami Viskin,Sami Viskin,Shmuel Banai,Shmuel Banai,Yacov Shacham,Yacov Shacham

doi:10.3390/jcm10112424

Aviram Hochstadt, Aviram Hochstadt + Show 17 more

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https://doi.org/10.3390/jcm10112424

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Abstract

Background. High-grade AV block (HGAVB) is a life-threatening condition. Acute kidney injury (AKI) which is usually caused by renal hypo-perfusion is associated with adverse outcomes. We aimed to investigate the association between AKI and HGAVB. Methods. This is a retrospective cohort comparing the incidence of AKI among patients with HGAVB requiring pacemaker implantation compared with propensity score matched controls. Primary outcome was the incidence of AKI at admission. Secondary outcomes were change in creatinine levels, AKI during stay, recovery from AKI, mortality and major adverse kidney events (MAKE). Results. In total, 80 HGAVB patients were compared to 400 controls. HGAVB patients had a higher proportion of admission AKI compared to controls (36.2% versus 21.1%, RR = 1.71 [1.21–2.41], p = 0.004). Creatinine changes from baseline to admission and to maximum during hospitalization, were also higher in HGAVB (p = 0.042 and p = 0.033). Recovery from AKI was more frequent among HGAVB patients (55.2% vs. 25.9%, RR = 2.13 [1.31–3.47], p = 0.004) with hospitalization time, MAKE and crude mortality similar (p > 0.158). Conclusions. AKI occurs in about one third of patients admitted with HGAVB, more frequent compared to controls. Patients with AKI accompanying HGAVB were likelier to recover from AKI. Further studies to explore this relationship could aid in clinical decision making for HGAVB patients.

Highlights

Significant atrio-ventricular conduction block (AVB) is a relatively uncommon clinical entity, but its incidence rises with age [1]
To estimate the incidence of Acute kidney injury (AKI) during High-grade AV block (HGAVB), our study population included all patients admitted to the Tel-Aviv Sourasky Medical center between 2007 and 2020, with diagnosis of HGAVB requiring pacemaker implantation, whose baseline renal function was known
Out of 492 patients admitted with HGAVB, the final study group consisted of 80 patients with clinically significant HGAVB and known baseline creatinine levels

Summary

Introduction

Significant atrio-ventricular conduction block (AVB) is a relatively uncommon clinical entity, but its incidence rises with age [1]. Patients with high-grade AVB (HGAVB), defined here as type II second degree and third degree AVB, may experience abrupt decline in cardiac output (CO), increased pulmonary artery pressure along with increased right-sided filling pressures and atrio-ventricular desynchrony [2,3]. These may lead to signs and symptoms of heart failure, weakness and syncope. Acute kidney injury (AKI), is a frequent occurrence in hospitalized patients and is associated with adverse clinical outcomes, including worsening of chronic renal failure, prolonged hospital stay, and increased mortality rates [4].

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