Journal article
Worsening Renal Function Is Common and Associated With Higher Mortality in Cardiogenic Shock: A Cardiogenic Shock Working Group Report
Journal of cardiac failure
01 Apr 2025
PMID: 40180238
Abstract
Outcomes associated with worsening renal function (WRF) in cardiogenic shock (CS) remain poorly understood.
To study the incidence of WRF in heart failure-CS (HF-CS) and acute myocardial infarction CS (AMI-CS), examine its association with in-hospital mortality (IHM), define the trajectory of renal function in CS, and identify independent predictors of WRF in HF-CS versus AMI-CS.
Patients in the Cardiogenic Shock Working Group registry (CSWG) from 2021-2024 were analyzed; those with baseline end-stage renal disease were excluded. WRF was defined as an increase in creatinine ≥0.3 mg/dl, a decrease in eGFR >25%, or initiation of renal replacement therapy (RRT) within 72 hours of CS diagnosis.
Of 6269 CS patients, 35% developed WRF, including 32% of HF-CS and 41% of AMI-CS patients. Patients who developed WRF were more likely to be transferred from other hospitals (63% vs 50%, p<0.001). Baseline right atrial pressure (RAP) was higher in both HF-CS (15 mmHg vs 12 mmHg, p<0.001) and AMI-CS (13 mmHg vs 11 mmHg, p=0.02) patients with WRF compared to patients without WRF. Incidence of WRF was higher among patients exposed to both tMCS and vasoactive agents as compared to vasoactive drugs alone (46% vs. 29%, p<0.001). Overall rate of RRT initiation was 20% throughout admission with higher rates in patients with acute on chronic versus de novo HF-CS and in patients with STEMI-CS versus NSTEMI-CS in the first 24 hours. IHM was higher in patients with WRF (41% vs 21%, p<0.001). In patients with WRF, median eGFR declined steadily throughout the first 72 hours after CS diagnosis. Key independent predictors of WRF included RAP, lactate, transfer status, in patients with HF-CS and CKD, lactate and transfer status in patients with AMI-CS.
WRF is common and deleterious in both HF- and AMI-CS. Given the early association with worse outcomes, WRF may not only be prognostic but also represent a potential therapeutic target in future CS studies.
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1 citations in Scopus
Details
- Title
- Worsening Renal Function Is Common and Associated With Higher Mortality in Cardiogenic Shock: A Cardiogenic Shock Working Group Report
- Creators
- Rachna Kataria - Brown UniversityShashank S Sinha - Inova Fairfax HospitalSong Li - Medical City Dallas HospitalQiuyue Kong - Tufts Medical CenterManreet Kanwar - Allegheny Health NetworkJaime Hernandez-Montfort - Baylor Scott & White HealthA Reshad Garan - Baylor Scott & White HealthJacob Abraham - Providence CollegeElric Zweck - Heinrich Heine University DüsseldorfVan-Khue Ton - Massachusetts General HospitalDavid M Dudzinski - Massachusetts General HospitalAnthony Faugno - Tufts Medical CenterMaryjane Farr - The University of Texas Southwestern Medical CenterEsther Vorovich - Cardiovascular Institute of the SouthShelley Hall - Baylor University Medical CenterMaya Guglin - Robert Wood Johnson University HospitalMohit Pahuja - University of Oklahoma Health Sciences CenterKevin John - Tufts Medical CenterAjar Kochar - Brigham and Women's HospitalVanessa Blumer - Inova Fairfax HospitalSaraschandra Vallabhajosyula - Brown UniversitySandeep Nathan - University of ChicagoNeil M Harwani - Tufts Medical CenterGavin W Hickey - University of Pittsburgh Medical CenterAndrew D Schwartzman - Maine Medical CenterWissam Khalife - The University of Texas Medical Branch at GalvestonClaudius Mahr - Medical City Dallas HospitalJu H Kim - Houston MethodistArvind Bhimaraj - Houston MethodistPaavni Sangal - Tufts Medical CenterKarol D Walec - Tufts Medical CenterPeter Zazzali - Tufts Medical CenterJustin Fried - Columbia University Irving Medical CenterDaniel Burkhoff - Cardiovascular Research FoundationNavin K Kapur - Tufts Medical Center
- Publication Details
- Journal of cardiac failure
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Scopus ID
- 2-s2.0-105006742485
- Other Identifier
- 991022043970004721