Impact of renal artery stenosis on acute kidney injury and outcomes after heart failure hospitalization

• Published in: The American journal of the medical sciences Vol. 365; no. 3; p. 242
• Main Authors: Devanaboyina, Monika, Shastri, Pinang, Thompson, Nicholas, Tsai, Luke, Bajrami, Silvi, Devarasetty, Pratyush Pavan, Brewster, Pamela, Dworkin, Lance D, Cooper, Christopher J, Gupta, Rajesh
• Format: Journal Article
• Language: English
• Published: United States 01.03.2023
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Heart Failure - complications; Heart Failure - epidemiology; Hospitalization; Humans; Percutaneous Coronary Intervention; Renal Artery Obstruction - complications; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - epidemiology; Retrospective Studies; Risk Factors; Heart failure; Hospitalization; Renal artery stenosis; Acute kidney injury; Renal duplex ultrasound
• ISSN: 1538-2990
• DOI: 10.1016/j.amjms.2022.10.001

Renal artery stenosis (RAS) is known to co-exist with heart failure (HF), however the impact of RAS on rates of acute kidney injury during an acute HF hospitalization, and adverse events after acute HF hospitalizations has not been well studied. We performed a retrospective cohort study of subjects hospitalized for acute HF at a tertiary academic care center. We identified subjects who had a renal artery duplex ultrasound or other diagnostic study for RAS to categorize heart failure subjects as RAS+ or RAS-. AKI was defined as a rise from admission to peak creatinine of >0.3 mg/dL or >1.5 fold. In-hospital outcomes including rates of AKI were ascertained. Adverse outcomes over a two-year follow up period were also ascertained. A total of 93 subjects with acute HF hospitalization met the inclusion criteria and were enrolled in this study; 27 (29%) were identified as RAS+. At admission, subjects with RAS had higher rates of diabetes and prior PCI. During the HF hospitalization, subjects with RAS were more likely to develop AKI. No significant differences were identified in baseline or hospital medication use among subjects with versus without RAS. Importantly, the rate of ACE-I/ARB use was low in both groups and no significant difference in ACE-I/ARB use was demonstrated. Subjects with RAS had higher rates of recurrent HF hospitalization during the follow-up period. RAS is prevalent among subjects with acute HF, associated with higher rates of AKI during HF hospitalization, and associated with higher rates of recurrent HF hospitalization during follow-up.