MP276
RISK FACTORS OF ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE CARDIAC DISEASES

INTRODUCTION AND AIMS: Acute kidney injury (AKI) is a common and serious problem associated with poor prognosis. The aim of the study was to assess the prevalence and predictors of AKI in patients with acute cardiac diseases.

METHODS: 566 patients (278 with decompensated heart failure (DHF), 288 with non-ST-elevation acute coronary syndrome (NSTE-ACS), 46% male, 71±11 years (M±SD), smokers 26%, arterial hypertension 91%, previous myocardial infarction (MI) 45%, diabetes mellitus (DM) 28%, atrial fibrillation 35%, chronic kidney disease (CKD) 46%, previous hospitalization with DHF 36%, ejection fraction (EF) <35% 15%, blood pressure (BP) 142±30/83±16 mmHg) were examined. AKI was diagnosed according to KDIGO 2012 Guidelines. Mann-Whitney test and multivariate logistic regression analysis were considered significant if p<0.05.

RESULTS: Incidence of AKI in all patients, patients with DHF and NSTE-ACS was 40, 43.5 and 37.2%. AKI stage 1 was prevalent. Patients with vs without AKI had higher rate of previous MI (56.6 vs 36.7%, p<0.001), stable angina (43.9 vs 33.9%, p<0.05), CKD (52 vs 41.4%, p<0.05), DM (33.6 vs 24.3%, p<0.05), obesity (48.5 vs 39.3%,p<0.05) acute HF or DHF at admission (74.7 vs 60.7%, p<0.001), MI at admission (39.3 vs 28.7%, p<0.05), anemia (38 vs 30%, p<0.05), serum creatinine (SCr) >118 μmol/l (50 vs 22%, p<0.01), systolic BP <110 mmHg (16.7 vs 8.3%, p<0.01). In-hospital mortality in patients with AKI was higher: in DHF 12.4 vs 5%, p<0.01, in NSTE-ACS 17.8 vs 3.3%, p<0.001. Independent predictors of AKI were: GFR <30 ml/min/1.73 m² (odds ratio (OR) 6.5, 95% confidential interval (CI) 3.4-12.6, p<0.001), SCr >118 μmol/l (OR 5.5, 95% CI 3.6-8.5, p<0.001), systolic BP <90 mmHg (OR 4.6, 95% CI 1.2-17.1) (all parameters at admission).

CONCLUSIONS: 40% of patients admitted to the hospital with NSTE-ACS and DHF developed AKI. Patients with baseline systolic BP <90 mmHg, GFRI <15 ml/min/1.73 m², SCr >118 μmol/l are at high-risk for development of AKI. AKI was associated with higher in-hospital mortality.