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Association Between Heart Failure Ejection Fraction Phenotypes and Contrast-Associated Acute Kidney Injury: A

Kaandeeban Mohanraj1, John Amerson2, Naveen Punchayil Narayanankutty2

  • 1Internal Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, IND.

Cureus
|May 13, 2026
PubMed

Insights

Contrast-associated acute kidney injury (CA-AKI) risk varies among heart failure (HF) types. Current evidence is limited, suggesting ejection fraction alone may not fully indicate kidney vulnerability in HF patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Research

Background:

  • Contrast-associated acute kidney injury (CA-AKI) is a known complication, particularly in heart failure (HF) patients.
  • The varying risk of CA-AKI across different heart failure phenotypes, stratified by left ventricular ejection fraction (LVEF), remains unclear.
  • Existing data comparing CA-AKI risk among heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF) is limited and inconsistent.

Purpose of the Study:

  • To systematically review and synthesize evidence on the risk of CA-AKI stratified by LVEF phenotypes in patients with heart failure.
  • To evaluate the association between HFrEF, HFmrEF, and HFpEF and the incidence of CA-AKI.

Main Methods:

  • A systematic literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from January 1, 2011, to December 11, 2025.
  • Two observational cohort studies, including 3,499 patients with HF, met the eligibility criteria.
  • Due to heterogeneity and limited data, a narrative synthesis of adjusted effect estimates was performed, with risk of bias assessed using ROBINS-E.

Main Results:

  • The two included studies reported multivariable-adjusted odds ratios for CA-AKI across HF phenotypes.
  • One study found no significant association between reduced EF and CA-AKI after adjustment (HFrEF vs. HFpEF adjusted OR 1.01; HFmrEF vs. HFpEF adjusted OR 1.31).
  • Another study suggested higher adjusted odds of CA-AKI with HFrEF compared to other phenotypes (adjusted OR 0.85).

Conclusions:

  • Current evidence on CA-AKI risk stratified by LVEF in HF patients is limited to two observational studies with inconsistent findings.
  • Pooled effect estimates could not be reported due to heterogeneity in study design, populations, and covariate adjustment.
  • Ejection fraction alone may not fully capture kidney vulnerability in HF patients, and further larger studies are needed to clarify these risks.

Keywords:
acute kidney injurycontrast-associated acute kidney injurycontrast-induced nephropathyejection fraction (ef)heart failureleft ventricular functionmeta-analysissystematic review

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