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The Egyptian Journal of Internal Medicine
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Prevalence of acute kidney injury in cardiac patients in the Intensive Care Unit

The Egyptian Journal of Internal Medicine volume 28, pages 60–65 (2016)Cite this article

Abstract

Background

Acute kidney injury (AKI) has consistently been associated with adverse clinical outcome after acute myocardial infarction (MI). In addition, AKI is well-known as a potent predictor of the clinical course in heart failure patients. The aim of this study was to assess the prevalence and risk factors of AKI in patients with acute MI and congestive heart failure (CHF) in the ICU at Zagazig University Hospitals, Egypt.

Patients and methods

This study included 100 patients with acute MI and 100 patients with CHF admitted to the ICU. They were subjected to careful history taking, thorough clinical examination, ECG and echocardiographic evaluation, and laboratory investigations, including cardiac enzyme evaluation, renal profile, and fasting blood glucose. Definitions of AKI depend on the measurement of serum creatinine as a surrogate marker for the glomerular filtration rate, in addition to the calculation of estimated glomerular filtration rate.

Results

The proportion of patients who experienced AKI was 47% in patients with CHF and 45% in patients with acute MI. They were significantly older in age (P=0.013 and 0.004, respectively). In CHF, patients with AKI had significantly higher fasting blood sugar (P=0.011), abnormal ECG changes (P=0.001), lower ejection fraction (P=0.034), and lower diastolic dysfunction (P=0.027). However, in acute MI, patients with AKI had significantly higher fasting blood sugar (P=0.013) and higher troponin I level (P=0.015).

Conclusion

The most important risk factors for AKI in patients with CHF are older age, higher frequency of diabetes mellitus, abnormal ECG changes, lower ejection fraction, and diastolic dysfunction. However, high troponin I and older age are the most important risk factors for AKI in patients with acute MI. Careful monitoring of susceptible patients in the ICU is recommended for early detection and management of AKI in those patients.

References

  1. Spanaus KS, Kronenberg F, Ritz E, Schlapbach R, Fliser D, Hersberger M, et al. Mild-to-Moderate Kidney Disease Study Group B-type natriuretic peptide concentrations predict the progression of nondiabetic chronic kidney disease: the Mild-to-Moderate Kidney Disease Study. Clin Chem 2007; 53: 1264–1272.

    Article  CAS  Google Scholar 

  2. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC. ADHERE Scientific Advisory Committee and Investigators Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol 2006; 47: 76–84.

    Article  Google Scholar 

  3. Mehta R, Feldman D. Acute decompensated heart failure: best evidence and current practice. Minerva Cardioangiol 2005; 53: 537–547.

    CAS  PubMed  Google Scholar 

  4. Shah SV. Oxidants and iron in chronic kidney disease. Kidney Int Suppl 2004; 66: S50–S55.

    Article  Google Scholar 

  5. Bagshaw SM, Cruz DN, Aspromonte N, Daliento L, Ronco F, Sheinfeld G, et al. Epidemiology of cardio-renal syndromes: workgroup statements from the 7th ADQI Consensus Conference. Nephrol Dial Transplant 2010; 25: 1406–1416.

    Article  Google Scholar 

  6. Berl T, Henrich W. Kidney-heart interactions: epidemiology, pathogenesis, and treatment. Clin J Am Soc Nephrol 2006; 1: 8–18.

    Article  CAS  Google Scholar 

  7. Anderson JL. ST segment elevation acute myocardial infarction and complications of myocardial infarction. In: Goldman L, Schafer AI, editors. Cecil medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011.

  8. Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. J Am Coll Cardiol 2007; 50: 2173–2195.

    Article  Google Scholar 

  9. Pagana KD, Pagana TJ. Mosby’s manual of diagnostic and laboratory tests. St Louis, MO: Mosby Inc.; 1998.

  10. Mazzachi BC, Peake MJ, Ehrhardt V. Reference range and method comparison studies for enzymatic and Jaffé creatinine assays in plasma and serum and early morning urine. Clin Lab 2000; 46: 53–55.

    CAS  PubMed  Google Scholar 

  11. Young DS. Effects of drugs on clinical lab tests. 4th ed. Washington, DC: AACC Press; 1995.

  12. Skali H, Uno H, Levey AS, Inker LA, Pfeffer MA, Solomon SD. Prognostic assessment of estimated glomerular filtration rate by the new Chronic Kidney Disease Epidemiology Collaboration equation in comparison with the Modification of Diet in Renal Disease Study equation. Am Heart J 2011; 162: 548–554.

    Article  Google Scholar 

  13. Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J, ADHERE Scientific Advisory Committee and Investigators. High prevalence of renal dysfunction and its impact on outcome in 118465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 2007; 13: 422–430.

    PubMed  Google Scholar 

  14. Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004; 351: 1285–1295.

    Article  CAS  Google Scholar 

  15. Stanojević D, Apostolović S, Janković-Tomasević R, Salinger-Martinović S, Pavlović M, Zivković M, et al. Prevalence of renal dysfunction and its influence on functional capacity in elderly patients with stable chronic heart failure. Vojnosanit Pregl 2012; 69: 840–845.

    Article  Google Scholar 

  16. Waldum B, Westheim AS, Sandvik L, Flønaes B, Grundtvig M, Gullestad L, et al. Renal function in outpatients with chronic heart failure. J Card Fail 2010; 16: 374–380.

    Article  Google Scholar 

  17. Kim CS, Kim MJ, Kang YU, Choi JS, Bae EH, Ma SK, et al. Influence of renal dysfunction on clinical outcomes in patients with congestive heart failure complicating acute myocardial infarction. Int Heart J 2013; 54: 304–310.

    Article  CAS  Google Scholar 

  18. McAlister FA, Ezekowitz J, Tarantini L, Squire I, Komajda M, Bayes-Genis A, et al. Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) Investigators Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new Chronic Kidney Disease-Epidemiology Collaboration Group formula. Circ Heart Fail 2012; 5: 309–314.

    Article  Google Scholar 

  19. Roik M, Starczewska MH, Stawicki S, Solarska-Półchłopek A, Warszawik O, Oreziak A, et al. The prognostic value of renal dysfunction in patients with chronic heart failure: 12-month follow-up. Kardiol Pol 2006; 64: 704–711.

    PubMed  Google Scholar 

  20. Petretta M, Scopacasa F, Fontanella L, Carlomagno A, Baldissara M, de Simone A, et al. Prognostic value of reduced kidney function and anemia in patients with chronic heart failure. J Cardiovasc Med (Hagerstown) 2007; 8: 909–916.

    Article  Google Scholar 

  21. Cohen N, Gorelik O, Almoznino-Sarafian D, Alon I, Tourovski Y, Weissgarten J, et al. Renal dysfunction in congestive heart failure, pathophysiological and prognostic significance. Clin Nephrol 2004; 61: 177–184.

    Article  CAS  Google Scholar 

  22. Bruch C, Rothenburger M, Gotzmann M, Wichter T, Scheld HH, Breithardt G, Gradaus R. Chronic kidney disease in patients with chronic heart failure – impact on intracardiac conduction, diastolic function and prognosis. Int J Cardiol 2007; 118: 375–380.

    Article  Google Scholar 

  23. Yang YH, Wang L, An F, Huang JH, Ma JP, Li GP, Li LF. Renal dysfunction and survival in hospitalized patients with chronic heart failure: a retrospective analysis. Zhonghua Xin Xue Guan Bing Za Zhi 2009; 37: 729–733.

    PubMed  Google Scholar 

  24. Langston RD, Presley R, Flanders WD, McClellan WM. Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction. Kidney Int 2003; 64: 1398–1405.

    Article  Google Scholar 

  25. Schiele F, Legalery P, Didier K, Meneveau N, Seronde MF, Caulfield F, et al. Impact of renal dysfunction on 1-year mortality after acute myocardial infarction. Am Heart J 2006; 151: 661–667.

    Article  CAS  Google Scholar 

  26. Ersbøll M, Valeur N, Hassager C, Søgaard P, Køber L. The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction. Am Heart J 2014; 167: 506–513.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Nephrology Unit, Zagazig University Hospital, PO Box 44519, Zagazig, Egypt

    Tarek A. Ghonemy MBBCh, MSc, MD, Hala M. Allam, Amir M. Elokely, Esam Lotfy & Sayed Elnahal

  2. Department of Medical Biochemistry, Zagazig University Hospital, Zagazig, Egypt

    Amal F. Gharib

Authors
  1. Tarek A. Ghonemy MBBCh, MSc, MD
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  2. Hala M. Allam
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  3. Amir M. Elokely
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  4. Esam Lotfy
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  5. Sayed Elnahal
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  6. Amal F. Gharib
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Correspondence to Tarek A. Ghonemy MBBCh, MSc, MD.

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Ghonemy, T.A., Allam, H.M., Elokely, A.M. et al. Prevalence of acute kidney injury in cardiac patients in the Intensive Care Unit. Egypt J Intern Med 28, 60–65 (2016). https://doi.org/10.4103/1110-7782.193886

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  • DOI: https://doi.org/10.4103/1110-7782.193886

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