SP249PREVALENCE AND OUTCOMES IN COMMUNITY − ACQUIRED VERSUS HOSPITAL − ACQUIRED ACUTE KIDNEY INJURY IN PATIENTS WITH DECOMPENSATED HEART FAILURE

Abstract

Objective: Acute kidney injury (AKI) is a common problem in patients hospitalized with acute decompensated heart failure (ADHF) and occurs up to 70%. Little is known about AKI acquired in the community (CA-AKI) and how it differs from hospital-acquired AKI (HA-AKI). The aim of the study was to determine the prevalence of CA-AKI and HA-AKI in ADHF patients and to evaluate the impact on short-term (30-days mortality) and long-term (6 months rate of ADHF rehospitalizations) outcomes. Methods: in 183 patients admitted with ADHF (125 male, 69+/-9 years (M+/-SD), arterial hypertension (AH) 87%, ischemic heart disease (IHD) 56%, myocardial infarction (MI) 53%, atrial fibrillation 51%, diabetes mellitus (DM) 36%, known chronic kidney disease (CKD) 40%, ejection fraction 44+/-15%) the prevalence of different variants of AKI was assessed. AKI was defined using 2012 KDIGO Guidelines. Depending on the timing of AKI, AKI was divided into CA-AKI, presenting on admission, and HA-AKI, that occurred after admission. Mann-Whitney and multiple logistic regression analysis were performed. P<0.05 was considered statistically significant. Results: 41% of patients developed AKI. CA-AKI was revealed in 56% of all AKI cases. Patients with CA-AKI versus HA-AKI were younger (65+/-8 vs 71+/-8 years, p<0.01), had lower rate of previous ADHF-hospotalizations (71 vs 100%, p<0.001). There was no difference in prevalence of main comorbidities, but there was tendence to higher rate of AH, IHD, DM, CKD and anemia in patients with CA-AKI. Patients with CA-AKI had higher risk of 30-days mortality (21 vs 12%, p<0.05) and similar 6 months rate of ADHF rehospitalizations (48 vs 49%, p>0.05). Conclusions: CA-AKI was more frequent in ADHF patients and developed in 56%. Patients with CA-AKI had higher risk of 30-days mortality than HA-AKI and similar rate of long-term outc omes.