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Risk factors and outcome variables of cardiorenal syndrome type 1 from the nephrologist's perspective
Dominik Seckinger1, Oliver Ritter1, Daniel Patschan2
1Klinik Für Kardiologie, Angiologie und Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Hochstraße 29, 14770, Brandenburg, Germany.
Insights
Cardiorenal syndrome (CRS) type 1, a complication of heart failure causing acute kidney injury (AKI), has a high incidence and mortality. Optimized follow-up is crucial for improving long-term outcomes in these patients.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Cardiorenal syndrome (CRS) type 1 links acute cardiac decompensation to acute kidney injury (AKI).
- AKI episodes elevate the long-term risk of chronic kidney disease (CKD).
Purpose of the Study:
- To evaluate the epidemiological characteristics and outcomes of CRS type 1 from a nephrologist's viewpoint.
- To identify risk factors for mortality and dialysis requirement in CRS type 1 patients.
Main Methods:
- Retrospective, observational study design.
- Screening of 1189 AKI patients for CRS type 1 diagnostic criteria.
- Analysis of in-hospital death, dialysis need, and renal recovery as endpoints.
Main Results:
- 16.6% of AKI patients were diagnosed with CRS type 1.
- In-hospital mortality was 19.2%; 9.6% required dialysis.
- Complete renal recovery occurred in 43.4% of patients; AKIN stage and diabetes predicted mortality.
Conclusions:
- CRS type 1 has a significant incidence and higher mortality than general AKI.
- Complete kidney function recovery is less frequent in CRS type 1.
- Improved kidney-specific follow-up is essential for better long-term patient outcomes.
Background And Aim:
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. In this study, we aimed to evaluate epidemiological characteristics and outcome variables of CRS type 1 individuals from the nephrologist's perspective.
Methods:
The 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.
Results:
During 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.
Conclusions:
The 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.
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