Key result
Admission kidney tubule biomarkers fail to predict AKI, while elevated BNP predicts ~130% more adverse events.
Why the study?
Serum creatinine frequently increases during acute heart failure hospitalizations meeting acute kidney injury criteria, but the significance of this increase is variable.
Do admission kidney tubule and cardiac biomarkers predict acute kidney injury or adverse in-hospital events in patients with acute heart failure?
Do admission kidney tubule and cardiac biomarkers predict acute kidney injury or adverse in-hospital events in patients with acute heart failure?
Admission kidney tubule and cardiac biomarkers do not reliably predict acute kidney injury or adverse in-hospital events in acute heart failure, suggesting creatinine changes are largely functional.
May warrant intensified renal monitoring in acute HF; extends evidence for tubule and cardiac biomarkers but should not yet change practice.
Background and hypothesis Serum creatinine frequently increases during hospitalizations for acute heart failure (AHF) meeting criteria for acute kidney injury (AKI), but the significance of this increase is variable. We evaluated whether admission levels of kidney tubule and cardiac biomarkers are associated with increases in serum creatinine and adverse in-hospital events. Methods In a nested case-control, we identified 214 cases with at least stage 1 AKI defined by the 2012 Kidney Disease Improving Global Outcomes criteria within seven days of admission in the Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin Evaluation of Symptomatic Heart Failure Study and matched with 214 controls who did not experience AKI. The primary outcome was the development of AKI within the first seven days; secondary outcomes were the development of severe AKI (stages 2 or 3) and a composite of adverse in-hospital events. Associations of 6 blood and 14 urine biomarkers were assessed with logistic regression and Receiver Operating Characteristic Area Under the Curve (ROC-AUC) curve analysis. Results Individuals were 71 ± 13 years; 64% were men; with median admission creatinine 1.3 [IQR 1.0–1.8] mg/dL. Among AKI cases, 181 (85%), 16 (8%), and 17 (8%) were stages 1, 2, and 3, respectively. Compared to the lowest tertile, only the highest tertiles of fractional excretion of sodium (FeNa ≥ 3.65; OR 1.7, 95% CI 1.0–2.9) and urinary MCP-1 (≥ 433 ng/g; OR 1.7, 95% CI 1.0–2.8) were associated with AKI risk, though discrimination was poor (ROC-AUC < 0.60). Neither was associated with severe AKI. Only elevated B-type natriuretic peptide (≥ 932 pg/mL) predicted the composite adverse in-hospital event (OR 2.3, 95% CI 1.2–4.2). Conclusion Kidney tubule and cardiac biomarkers at admission for AHF are not associated with risk for increases in creatinine or adverse in-hospital events reaffirming that creatinine changes in AHF are largely functional in nature.
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Duff et al. (2026) studied this question. Admission kidney tubule biomarkers in acute heart failure poorly predict acute kidney injury (ROC-AUC < 0.60), while only elevated BNP predicts adverse in-hospital events (OR 2.3).
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