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Prognostic value of dynamic KDIGO staging in acute kidney injury after acute heart failure: a doubly robust analysis

Ying Jin1, Chao Feng1, Hantao Jiang1

  • 1Department of Cardiology, Chest Hospital, Tianjin University, No. 70 Xi'an Road, Heping District, Tianjin, 300051, China.

Scientific Reports
|July 2, 2025
PubMed

Insights

Acute kidney injury (AKI) in acute heart failure (AHF) patients shows moderate-to-severe stages significantly increase mortality. Mild AKI, or subclinical AKI, has similar outcomes to no AKI unless it progresses.

Area of Science:

  • Nephrology
  • Cardiology
  • Critical Care Medicine

Background:

  • Acute kidney injury (AKI) is a common, serious complication in patients with acute heart failure (AHF).
  • The prognostic significance of different stages of AKI, according to KDIGO criteria, in AHF patients remains under-investigated.
  • Understanding dynamic AKI progression is crucial for predicting outcomes in AHF.

Purpose of the Study:

  • To investigate the prognostic impact of dynamic KDIGO AKI staging on mortality in intensive care unit (ICU) patients with AHF.
  • To compare outcomes across different AKI severity stages and progression patterns.

Main Methods:

  • Retrospective cohort study using the MIMIC-IV database (2008-2022).
  • Included 5136 adult patients diagnosed with AHF.
  • Employed propensity score matching and doubly robust analysis to assess mortality at 28 days, 180 days, and 1 year.

Main Results:

  • No significant difference in mortality was observed between non-AKI and mild AKI groups at any time point.
  • Moderate-to-severe AKI was associated with significantly higher mortality compared to normal or mild AKI.
  • Progression from mild to moderate-to-severe AKI worsened patient outlook.
  • Transient AKI in AHF patients with AHF as the primary diagnosis did not significantly impact long-term outcomes.

Conclusions:

  • Dynamic KDIGO AKI staging is critical for prognostication in AHF patients.
  • Moderate-to-severe AKI poses a substantial mortality risk, whereas mild AKI may not independently worsen prognosis unless it progresses.
  • Transient AKI in specific AHF subgroups may have limited long-term prognostic implications.

Keywords:
Acute heart failureAcute kidney injuryDoubly robust analysisDynamic KDIGOPrognosisPropensity score matching

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