Acute Kidney Injury and Risk of Incident Heart Failure Among US Veterans

Am J Kidney Dis. 2018 Feb;71(2):236-245. doi: 10.1053/j.ajkd.2017.08.027. Epub 2017 Nov 20.

Abstract

Background: Acute kidney injury (AKI) is common and associated with poor outcomes. Heart failure is a leading cause of cardiovascular disease among patients with chronic kidney disease. The relationship between AKI and heart failure remains unknown and may identify a novel mechanistic link between kidney and cardiovascular disease.

Study design: Observational study.

Setting & participants: We studied a national cohort of 300,868 hospitalized US veterans (2004-2011) without a history of heart failure.

Predictor: AKI was the predictor and was defined as a 0.3-mg/dL or 50% increase in serum creatinine concentration from baseline to the peak hospital value. Patients with and without AKI were matched (1:1) on 28 in- and outpatient covariates using optimal Mahalanobis distance matching.

Outcomes: Incident heart failure was defined as 1 or more hospitalization or 2 or more outpatient visits with a diagnosis of heart failure within 2 years through 2013.

Results: There were 150,434 matched pairs in the study. Patients with and without AKI during the index hospitalization were well matched, with a median preadmission estimated glomerular filtration rate of 69mL/min/1.73m2. The overall incidence rate of heart failure was 27.8 (95% CI, 19.3-39.9) per 1,000 person-years. The incidence rate was higher in those with compared with those without AKI: 30.8 (95% CI, 21.8-43.5) and 24.9 (95% CI, 16.9-36.5) per 1,000 person-years, respectively. In multivariable models, AKI was associated with 23% increased risk for incident heart failure (HR, 1.23; 95% CI, 1.19-1.27).

Limitations: Study population was primarily men, reflecting patients seen at Veterans Affairs hospitals.

Conclusions: AKI is an independent risk factor for incident heart failure. Future studies to identify underlying mechanisms and modifiable risk factors are needed.

Keywords: HF risk factor; Kidney; acute kidney injury (AKI); cardiovascular disease (CVD); heart failure (HF); incident HF; kidney failure.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Kidney Injury* / blood
  • Acute Kidney Injury* / epidemiology
  • Aged
  • Cardiovascular Diseases / epidemiology*
  • Cohort Studies
  • Creatinine / blood*
  • Disease Progression
  • Female
  • Glomerular Filtration Rate
  • Heart Failure* / epidemiology
  • Heart Failure* / therapy
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Kidney / physiopathology
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic* / diagnosis
  • Renal Insufficiency, Chronic* / epidemiology
  • Renal Insufficiency, Chronic* / physiopathology
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology
  • Veterans / statistics & numerical data

Substances

  • Creatinine