Acute kidney injury in acute decompensated heart failure: clinical predictors and In-hospital outcomes at a tertiary center

Acute kidney injury (AKI) frequently complicates acute decompensated heart failure (ADHF) and is associated with adverse outcomes. Understanding its incidence, risk factors, and clinical consequences is essential for improving patient care. We conducted a retrospective observational study of 512 patients admitted with ADHF to King Abdullah Medical City, Makkah, between January 2023 and January 2024. Demographic, clinical, echocardiographic, and laboratory data were reviewed. AKI was defined using KDIGO criteria as a serum creatinine rise ≥0.3 mg/dL within 48 hours. Multivariate logistic regression identified independent predictors. The study was approved by the institutional ethics committee (approval 24-1280), with consent waived in accordance with the Declaration of Helsinki. AKI developed in 25% of patients (n = 122). Diabetes mellitus was an independent predictor (OR 2.26, 95% CI: 1.36-3.75, p < 0.001), and age ≥70 years was significantly associated (p = 0.002). Continuous diuretic infusion, however, was linked to lower AKI risk (OR 0.27, 95% CI: 0.18-0.42, p < 0.001). Patients with AKI had longer hospital stays compared with those without (12.0 ± 10.9 vs. 8.6 ± 12.3 days, p = 0.004). In-hospital mortality was higher in the AKI group (4.1% vs. 1.5%), though not statistically significant (OR 2.73, 95% CI: 0.82-9.10, p = 0.10). AKI is a common complication among patients hospitalized with ADHF, particularly in older adults and those with diabetes. Continuous diuretic infusion may reduce risk. Early recognition and tailored management are critical to preventing kidney injury and improving outcomes. Not applicable.