Key result
Lack of prior RAASb and low 25(OH)D are linked to death or dialysis at discharge.
Why the study?
Cardiorenal syndromes involve heart-kidney cross-talk and high morbidity and mortality, prompting evaluation of the prognostic role of risk factors and biomarkers in hospitalized patients.
Are specific risk factors and biomarkers associated with death or dialysis dependence at discharge in patients hospitalized for cardiorenal syndromes?
Cohort (n=100)
Are specific risk factors and biomarkers associated with death or dialysis dependence at discharge in patients hospitalized for cardiorenal syndromes?
Lack of prior RAASb use, high PTH, low 25(OH)D levels, and a low 25(OH)D/PTH ratio are associated with a poor prognosis (death or dialysis dependence) in patients hospitalized for cardiorenal syndromes.
May aid prognostication in cardiorenal hospitalizations; hypothesis-generating for RAASb or vitamin D intervention trials.
BACKGROUND: Cardiorenal syndromes (CRS), involving the heart-kidney cross-talk and the activation of neurohumoral and inflammatory pathways, are an entity characterized by high morbidity and mortality. OBJECTIVE: To evaluate the prognostic role of risk factors and biomarkers in patients hospitalized for CRS. METHODS: In this observational cohort study, 100 consecutive patients hospitalized for CRS were enrolled. Socio-demographic characteristics, personal medical history, and prior medication use were recorded upon admission, and echocardiography was performed. Moreover, an array of blood markers were measured. The endpoint of interest was a composite of death or dialysis dependence at discharge. RESULTS: Patients were classified into two groups; Group 1 (N= 52): discharged being dialysis-independent, Group 2 (N=48): death/dialysis dependence at discharge. No significant differences were detected in baseline characteristics between the two groups. Group 2 patients used renin-angiotensin-aldosterone system blockers (RAASb) less often and more frequently presented with oliguria/anuria. Group 2 patients had significantly lower hemoglobin, serum albumin, and 25-hydroxy-vitamin D (25(OH)D). At the same time, serum phosphate, potassium, and parathyroid hormone (PTH) were significantly higher in Group 2 patients. In a multivariate regression analysis, lack of prior RAASb and lower 25(OH)D levels were independently associated with an increased risk of death or dialysis dependence at discharge. 25(OH)D/PTH ratio was the most accurate predictor of the composite endpoint (Sensitivity: 79.4%, Specificity: 70.4%). CONCLUSION: Lack of prior RAASb use, high PTH, low 25(OH)D levels, and low 25(OH) D/PTH ratio are associated with a poor prognosis in patients hospitalized for CRS.
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Theofilis et al. (2022) conducted a cohort in Cardiorenal syndromes (n=100). Lack of prior RAASb use and low 25(OH)D levels vs. Prior RAASb use and higher 25(OH)D levels was evaluated on Composite of death or dialysis dependence at discharge. Lack of prior RAASb use and low 25(OH)D levels were independently associated with death or dialysis dependence at discharge, with the 25(OH)D/PTH ratio being the most accurate predictor.
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