Abstract
Acute kidney injury (AKI) has consistently been associated with adverse clinical outcome after acute myocardial infarction (MI). In addition, AKI is well-known as a potent predictor of the clinical course in heart failure patients. The aim of this study was to assess the prevalence and risk factors of AKI in patients with acute MI and congestive heart failure (CHF) in the ICU at Zagazig University Hospitals, Egypt. This study included 100 patients with acute MI and 100 patients with CHF admitted to the ICU. They were subjected to careful history taking, thorough clinical examination, ECG and echocardiographic evaluation, and laboratory investigations, including cardiac enzyme evaluation, renal profile, and fasting blood glucose. Definitions of AKI depend on the measurement of serum creatinine as a surrogate marker for the glomerular filtration rate, in addition to the calculation of estimated glomerular filtration rate. The proportion of patients who experienced AKI was 47% in patients with CHF and 45% in patients with acute MI. They were significantly older in age (P=0.013 and 0.004, respectively). In CHF, patients with AKI had significantly higher fasting blood sugar (P=0.011), abnormal ECG changes (P=0.001), lower ejection fraction (P=0.034), and lower diastolic dysfunction (P=0.027). However, in acute MI, patients with AKI had significantly higher fasting blood sugar (P=0.013) and higher troponin I level (P=0.015). The most important risk factors for AKI in patients with CHF are older age, higher frequency of diabetes mellitus, abnormal ECG changes, lower ejection fraction, and diastolic dysfunction. However, high troponin I and older age are the most important risk factors for AKI in patients with acute MI. Careful monitoring of susceptible patients in the ICU is recommended for early detection and management of AKI in those patients.
Highlights
The heart and kidneys are the organs that are richly vascular
Both organs are supplied by sympathetic and parasympathetic innervations. These two organs act in tandem to regulate blood pressure, vascular tone, diuresis, natriuresis, intravascular volume homeostasis, peripheral tissue perfusion, and oxygenation [1]. They have endocrine functions with interdependent physiological hormonal actions regulated by natriuretic peptides, especially atrial natriuretic peptide, a vasodilator secreted from the heart, and rennin–angiotensin–aldosterone system [2]
Acute kidney injury (AKI) was considered when Estimated glomerular filtration rate (eGFR) was less than 60 ml/min/1.73 m2 [12] or serum creatinine was 0.3 mg/dl greater from the baseline [5]
Summary
The heart and kidneys are the organs that are richly vascular (the kidneys are more vascular compared with the heart) Both organs are supplied by sympathetic and parasympathetic innervations. These two organs act in tandem to regulate blood pressure, vascular tone, diuresis, natriuresis, intravascular volume homeostasis, peripheral tissue perfusion, and oxygenation [1]. They have endocrine functions with interdependent physiological hormonal actions regulated by natriuretic peptides, especially atrial natriuretic peptide, a vasodilator secreted from the heart, and rennin–angiotensin–aldosterone system [2]. Definitions of AKI depend on the measurement of serum creatinine as a surrogate marker for the glomerular filtration rate, in addition to the calculation of estimated glomerular filtration rate
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