#6405 PROGRESSION TO END-STAGE RENAL DISEASE AND ONE-YEAR MORTALITY IN ACUTE CARDIORENAL SYNDROME
Authors: Rincón María Muñiz , Delgado-Palacios Jesús Domínguez , Meneses Arianne Aiffil , Arevalo Marta Calvo , Almudena Juez Del Pozo , Salazar Sara Huertas , López Rómulo Katsu Loayza , Carro Clara García , Romero Natividad Calvo , Ferreras Elena Ruiz , Fructuoso Ana Sanchez 
Published: June 2023

Abstract

Background and Aims
Approximately 25% of patients with chronic congestive heart failure (CHF) present a reduction in glomerular filtration rate (GFR) independent of the left ventricular ejection fraction (LVEF). A meta-analysis of 80,000 patients revealed that patients with lower GFR (&lt;53 mL/min) had a higher one-year mortality rate (51% versus 38%). Therefore, this reduction in GFR seems to have an important impact on both morbidity and mortality. The aim of this study was to analyze the factors associated with progression to advanced chronic kidney disease (CKD) and one-year mortality in a retrospective cohort of patients hospitalized due to acute decompensation of cardiorenal syndrome (CRS).

Method
Patients hospitalized for CRS between September-2013 and June-2020 who presented acute kidney injury (AKI) associated with CHF. Clinical, analytical and echocardiographic data were analyzed.

Results
The study included 100 patients with a majority of males (64%) and a median age of 79.5 years (72.3-85.0). Around 38% of the patients were dependent, 49% had ischemic heart disease, 51% were diabetic, 27% had left ventricular hypertrophy, 56% had moderate to severe pulmonary hypertension, and 59% had moderate to severe valve disease. In terms of LVEF, 27% showed severe dysfunction while 42% had preserved function. The median baseline creatinine was 1.6 mg/dl (1.3-2.0) with an estimated glomerular filtration rate (eGFR) of 36 ml/min (29.0-46.5). At the time of acute renal failure (ARF), creatinine was 3.3 mg/dl (2.8-4.0) and at hospital discharge the eGFR (CKD-EPI) was 29.5 ml/min (20.1-40.0). After one year of follow-up, 49 patients had died, 7 were admitted?? for chronic hemodialysis, and 6 showed a drop in eGFR greater than 40%. A logistic regression analysis was conducted for the outcome variable of "death or severe progression of CKD (considering entry into CKD grade V or loss of more than 40% of GFR)". Hyperphosphatemia (76% death/progression vs 48%, p=0.004), discharge eGFR less than 30 ml/min (74% vs 50%, p=0.013), and renin-angiotensin system (RAS) blockade (48.1% vs 77.1%) were significantly associated with the outcome. Systolic dysfunction was associated with 70.4% of death/progression (52.2% p=0.06). In the multivariate analysis, variables with a trend in the univariate analysis (p&lt;0.2), such as prolonged hospital stay, non-revascularized coronary disease, hyponatremia, and proteinuria, were included. The analysis showed that five variables were significantly associated with the risk of death/CKD progression: proteinuria (OR 2.8, 95% CI 1.03-7.37, p=0.04), discharge eGFR (OR 2.7, 95% CI 1.05-6.82, p=0.04), LVEF (OR 0.97, 95% CI 0.94-1.00, p=0.06), hyponatremia (OR 0.89, 95% CI 0.80-0.99, p=0.04), and RAS blockade (OR 0.19, 95% CI 0.07-0.53, p=0.001). The predictive model had an area under the curve of 0.79 (95% CI 0.70-0.88) with a p-value of 0.047 and a global accuracy of 77%.

Conclusion
In conclusion, our study found that hyponatremia and proteinuria were significantly associated with a poorer outcome in terms of CKD progression and mortality in patients with cardiorenal syndrome. Conversely, higher left ventricular ejection fraction and a higher estimated glomerular filtration rate at discharge from the decompensation episode were linked to a lower risk. Our findings support the use of RAS-blocking drugs as beneficial in this population.