Kidney Injury in Patients with Heart Failure-Related Cardiogenic Shock: Results from an International, Multicentre Cohort Study
Jonas Sundermeyer, Caroline Kellner, Benedikt N. Beer, Lisa Besch, Angela Dettling, Letizia Bertoldi, Stefan Blankenberg, Jeroen Dauw, Dennis Eckner, Ingo Eitel, Tobias Graf, Patrick Horn, Joanna Jozwiak‐Nozdrzykowska, Paulus Kirchhof, Stefan Kluge, Axel Linke, Ulf Landmesser, Enzo Lüsebrink, Nicolas Majunke, Norman Mangner, Sven Möbius Winkler, Peter Nordbeck, Martin Orban, Federico Pappalardo, Matthias Pauschinger, Michal Pazderník, Alastair Proudfoot, Matthew Kelham, Tienush Rassaf, H. Reichenspurner, Clemens Scherer, P. Christian Schulze, Robert H. G. Schwinger, Carsten Skurk, Marek Šramko, Guido Tavazzi, Hölger Thiele, Luca Villanova, Nuccia Morici, Ephraim B. Winzer, Dirk Westermann, Benedikt Schrage
Abstract
Abstract Aims Heart failure–related cardiogenic shock (HF-CS) accounts for about half of CS cases, with a paucity of data regarding the role of kidney injury in this subset. This study aims to evaluate patient characteristics and outcome associated with renal function in patients with HF-CS. Methods and results In this multicentre, international, retrospective study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation, complications, and 30-day mortality, based on renal function, adjusted logistic and Cox regression models were fitted. Among 1010 HF-CS patients, the median age was 64 (interquartile range [IQR] 52–75) years, with 71.7% being male. Median baseline creatinine was 1.7 (IQR 1.2–2.5) mg/dl, corresponding to an estimated glomerular filtration rate (eGFR) of 41.0 (IQR 25.2–62.2) ml/min/1.73 m2. In patients with acute kidney injury (AKI), 30-day mortality increased with AKI stages (no AKI 41.7%, AKI stage 1 43.3%, AKI stage 2 50.0%, AKI stage 3 63.7%; adjusted hazard ratio [HR] for AKI stage 3 1.97, 95% confidence interval [CI] 1.56–2.48, p < 0.001). Similarly, severe renal dysfunction (eGFR ≤ median) was associated with a 21% higher 30-day mortality risk (61.0% vs. 40.1%; adjusted HR 1.48, 95% CI 1.20–1.84, p < 0.001). Sepsis and bleeding were associated with both AKI and renal dysfunction, even after adjustment. Conclusions In HF-CS, kidney injury is associated with higher 30-day mortality, potentially mediated by bleeding and sepsis. These findings support the consideration of kidney function as a prognostic marker and call for the development and evaluation of kidney-restoring adjunct interventions in HF-CS.