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Open Access Open Badges Research article

Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: impact on outcomes

Qiugen Zhou123, Chunmei Zhao123, Di Xie123, Dingli Xu4, Jianping Bin4, Pingyan Chen5, Min Liang123, Xun Zhang123 and Fanfan Hou123*

Author Affiliations

1 Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China

2 Guangdong Provincial Institute of Nephrology, Guangzhou, China

3 Key Lab for Organ Failure Research, Ministry of Education, Guangzhou, China

4 Division of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China

5 Department of biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China

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BMC Nephrology 2012, 13:51  doi:10.1186/1471-2369-13-51

Published: 2 July 2012



Acute worsening of renal function, an independent risk factor for adverse outcomes in acute decompensated heart failure (ADHF), occurs as a consequence of new onset kidney injury (AKI) or acute deterioration of pre-existed chronic kidney disease (CKD) (acute-on-chronic kidney injury, ACKI). However, the possible difference in prognostic implication between AKI and ACKI has not been well established.


We studied all consecutive patients hospitalized with ADHF from 2003 through 2010 in Nanfang Hospital. We classified patients as with or without pre-existed CKD based on the mean estimated glomerular filtration rate (eGFR) over a six-month period before hospitalization. AKI and ACKI were defined by RIFLE criteria according to the increase of the index serum creatinine.


A total of 1,005 patients were enrolled. The incidence of ACKI was higher than that of AKI. The proportion of patients with diuretic resistance was higher among patients with pre-existed CKD than among those without CKD (16.9% vs. 9.9%, Pā€‰=ā€‰0.002). Compared with AKI, ACKI was associated with higher risk for in-hospital mortality, long hospital stay, and failure in renal function recovery. Pre-existed CKD and development of acute worsening of renal function during hospitalization were the independent risk factors for in-hospital death after adjustment by the other risk factors. The RIFLE classification predicted all-cause and cardiac mortality in both AKI and ACKI.


Patients with ACKI were at greatest risk of adverse short-term outcomes in ADHF. Monitoring eGFR and identifying CKD should not be ignored in patients with cardiovascular disease.

Acute decompensated heart failure; Acute kidney injury; Acute-on-chronic kidney injury; Outcome