MP199COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY IS ASSOCIATED WITH CARDIOHEPATIC SYNDROME IN DECOMPENSATED HEART FAILURE

Abstract

Introduction and Aims: Liver and kidney dysfunction is frequently encountered in heart failure and related to worse prognosis. Over the last several years interdependent feedback mechanisms involving the heart, kidney and liver have been discussed. The aim of the study was to assess the prevalence of acute kidney injury (AKI) and abnormal liver function tests (LFTs) and their interrelations in acute decompensated heart failure (ADHF). Methods: In 322 patients with ADHF (190 male, 69.5±10.7 years (M±SD), arterial hypertension 87%, myocardial infarction 56.5%, atrial fibrillation 65.5%, diabetes mellitus 41.6%, known chronic kidney disease 39.1%, chronic anemia 29.2%, chronic obstructive lung disease 32.2%, ejection fraction (EF) 37.6±12.6%, EF <35% 39.1%) alanine transaminase (ALT), aspartate transaminase (AST), direct and total bilirubin (DB and TB), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT) and international normalized ratio (INR) were measured on admission. LFTs were considered abnormal when levels exceeded local upper normal limit. Patients on warfarin were excluded from INR analysis. AKI was diagnosed based on KDIGO 2012 Guidelines. Mann-Whitney test and multivariate logistic regression analysis were performed, p<0.05 was considered statistically significant. Results: Abnormal LFTs occurred in 274 (85.1%) patients. Increase of transaminases were detected in 68 (21.1%) patients (alone ALT/ alone AST/ both TA in 35.3, 26.5, 38.2% respectively), DB and/or TB in 264 (82%) patients (alone DB/ alone TB/ DB and TB - in 28, 0.8, 71.2% respectively), AP in 90 (27.9%) and GGT in 102 (31.7%) patients. Mean value ALT was 34.9±46.5 U/l, AST 34.6±25.7U/l, DB 9.6±7.1 μmol/l, TB 26.3 ±14.5 μmol/l, GGT 115.6±85.9 U/l, AP 113.9±85.4 U/l, INR 1.33±029. Community-acquired AKI (CA-AKI) was diagnosed in 60 (18.6%) patients. Patients with versus without CA-AKI had higher levels of ALT (60±88 vs 29±26 U/l, p<0.05), AST (52±45 vs 31±16 U/l, p<0.001), TB (29±13 vs 25±15 μmol/l, p<0.01), DB (12±7 vs 9±7 μmol/l, p<0.001), GGT (157±117 vs 102±68 U/l, p<0.001), AP (124±74 vs 112±88 U/l, p<0.05), INR (1.49±0.42 vs 1.29±0.23, p<0.01). Patients with vs without AKI had higher prevalence of increase of ALT (30 vs 12.3%, p<0,001), AST (33.3 vs 9.2%, p<0,001), TB (73.3 vs 56.2%, p<0.05) and INR (60.8% vs 43.8%, p<0,05). AKI was predictor for increase of ALT (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6-5.9), AST (OR 4.9, CI 2.5-9.7), TB (OR 2.1, CI 1.2-4.0) and INR (OR 2.0, CI 1.0-3.9). Conclusions: CA-AKI occurred in 18.6%, abnormal LFTs - in 85.1% of patients admitted with ADHF. Patients with versus without AKI had higher prevalence of abnormal LFTs. In patients with ADHF increase of transaminases, total bilirubin and INR can directly contribute to AKI and vice versa.