Abstract
Background and aimIn cardiorenal syndrome (CRS) type 1, acute cardiac failure or acute decompensation of chronic heart failure causes acute kidney injury (AKI). Every individual AKI episode increases the risk for chronic kidney disease (CKD) in the long term. In this study, we aimed to evaluate epidemiological characteristics and outcome variables of CRS type 1 individuals from the nephrologist’s perspective.MethodsThe study was performed in a retrospective, observational manner. All AKI patients treated at the Brandenburg Hospital of the Medical School of Brandenburg between January and December 2019 were screened for diagnostic criteria of CRS type 1. Endpoints were in-hospital death, need for dialysis, and renal recovery.ResultsDuring the screening, 198 out of 1189 (16.6%) AKI subjects were assigned to the diagnosis CRS type 1. The overall in-hospital mortality was 19.2%; 9.6% of the patients required dialysis due to AKI. Complete recovery of kidney function was observed in 86 individuals (43.4%); incomplete recovery occurred in 55 patients (27.8%). Mortality-predictive variables were AKIN stage 2, longer ICU treatment, and insulin-dependent diabetes. Regarding dialysis, AKIN stage 3 and higher potassium at the time of diagnosis were predictive. Subjects with longer in-hospital stay recovered more often from CRS type 1.ConclusionsThe incidence of CRS type 1 is high (∼16% of all in-hospital AKI subjects) and the mortality is higher than the average mortality of AKI in general. At the same time, complete recovery of kidney function occurs less frequent. The kidney-related follow-up management of CRS type 1 needs to be significantly optimized to improve the long-term outcome of affected patients.
Highlights
In 2008, Ronco et al introduced the concept of cardiorenal syndromes (CRS) [1]
The current study reports on epidemiology and outcome of CRS type 1 patients treated at a cardiorenal unit over the year 2019
Li et al found an average mortality of 23.5% in acute heart failure (AHF) patients with acute kidney injury (AKI) as compared to 7.2% of AHF subjects without deteriorated kidney function [23]
Summary
In 2008, Ronco et al introduced the concept of cardiorenal syndromes (CRS) [1] It differentiates between five distinct CRS types, from which all are characterized by a simultaneous affection of both heart and kidney function/structure in an either acute or chronic manner. In CRS type 1, acute cardiac failure or acute decompensation of chronic heart failure impairs kidney function [2]. AKI evolves in up to 30% of all hospitalized subjects in central Europe and the US [4] It represents a major challenge for physicians all over the world, since early diagnosis is difficult and therapeutic measures are limited to say the least [5,6,7]. In cardiorenal syndrome (CRS) type 1, acute cardiac failure or acute decompensation of chronic heart failure causes acute kidney injury (AKI). Every individual AKI episode increases the risk for chronic kidney disease (CKD) in the long term. The kidney-related follow-up management of CRS type 1 needs to be significantly optimized to improve the long-term outcome of affected patients
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