AIMS: Heart failure-related cardiogenic shock (HF-CS) accounts for about half of CS cases, with a paucity of data regarding the role of kidney injury in this subset. This study aims to evaluate patient characteristics and outcome associated with renal function in patients with HF-CS. METHODS AND RESULTS: In this multicentre, international, retrospective study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation, complications, and 30-day mortality, based on renal function, adjusted logistic and Cox regression models were fitted. Among 1010 HF-CS patients, the median age was 64 (interquartile range [IQR] 52-75) years, with 71.7% being male. Median baseline creatinine was 1.7 (IQR 1.2-2.5) mg/dl, corresponding to an estimated glomerular filtration rate (eGFR) of 41.0 (IQR 25.2-62.2) ml/min/1.73 m2. In patients with acute kidney injury (AKI), 30-day mortality increased with AKI stages (no AKI 41.7%, AKI stage 1 43.3%, AKI stage 2 50.0%, AKI stage 3 63.7%; adjusted hazard ratio [HR] for AKI stage 3 1.97, 95% confidence interval [CI] 1.56-2.48, p < 0.001). Similarly, severe renal dysfunction (eGFR ≤ median) was associated with a 21% higher 30-day mortality risk (61.0% vs. 40.1%; adjusted HR 1.48, 95% CI 1.20-1.84, p < 0.001). Sepsis and bleeding were associated with both AKI and renal dysfunction, even after adjustment. CONCLUSIONS: In HF-CS, kidney injury is associated with higher 30-day mortality, potentially mediated by bleeding and sepsis. These findings support the consideration of kidney function as a prognostic marker and call for the development and evaluation of kidney-restoring adjunct interventions in HF-CS.

Anesthesia and Intensive Care Fondazione Policlinico San Matteo Hospital IRCCS Pavia Italy

Cardio Center Humanitas Clinical and Research Center IRCCS Rozzano Italy

Cardiovascular Center Aalst OLV Hospital Aalst Belgium

Center for Population Health Innovation University Heart and Vascular Center Hamburg University Medical Center Hamburg Eppendorf Hamburg Germany

Department for Internal Medicine and Cardiology Heart Center Dresden Dresden University of Technology Dresden Germany

Department of Cardiology and Angiology University Heart Center Freiburg Bad Krozingen Freiburg Germany

Department of Cardiology and Vascular Medicine West German Heart and Vascular Center University Hospital Essen Essen Germany

Department of Cardiology Angiology and Intensive Care Medicine Deutsches Herzzentrum der Charité Campus Benjamin Franklin Berlin Germany

Department of Cardiology IKEM Prague Czech Republic

Department of Cardiology Paracelsus Medical University Nürnberg Nürnberg Germany

Department of Cardiology University Heart and Vascular Center Hamburg University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Cardiothoracic and Vascular Anesthesia and Intensive Care AO SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

Department of Cardiothoracic Surgery University Heart and Vascular Center Hamburg University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Clinical Surgical Diagnostic and Paediatric Sciences University of Pavia Pavia Italy

Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Internal Medicine 1 University Hospital Jena Jena Germany

Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany

Department of Internal Medicine and Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Science Leipzig Germany

Department of Medicine 1 University Hospital LMU Munich Munich Germany

Department of Perioperative Medicine St Bartholomew's Hospital London UK

Division of Cardiology Pulmonology and Vascular Medicine Medical Faculty University Duesseldorf Duesseldorf Germany

German Center for Cardiovascular Research Partner site Hamburg Kiel Lübeck Hamburg Germany

IRCCS Fondazione Don Gnocchi ONLUS Santa Maria Nascente Milan Italy

Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany

Unità di Cure Intensive Cardiologiche and De Gasperis Cardio Center ASST Grande Ospedale Metropolitano Niguarda Milan Italy

University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany

Zobrazit více v PubMed

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, PubMed DOI

Naidu SS Baran DA Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, et al. SCAI SHOCK stage classification expert consensus update: A review and incorporation of validation studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol 2022. 79 933 946 10.1016/j.jacc.2022.01.018 PubMed DOI

Van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, PubMed DOI

Osman M, Syed M, Patibandla S, Sulaiman S, Kheiri B, Shah MK, PubMed DOI PMC

Helgestad OKL, Josiassen J, Hassager C, Jensen LO, Holmvang L, Sørensen A, PubMed DOI

Schrage B, Becher PM, Goßling A, Savarese G, Dabboura S, Yan I, PubMed DOI PMC

Berg DD, Bohula EA, van Diepen S, Katz JN, Alviar CL, Baird‐Zars VM, et al. Epidemiology of shock in contemporary cardiac intensive care units. Circ Cardiovasc Qual Outcomes 2019;12(3):e005618. 10.1161/CIRCOUTCOMES.119.005618 PubMed DOI PMC

Shah M, Patnaik S, Patel B, Ram P, Garg L, Agarwal M, PubMed DOI

Thiele H, Ohman EM, De Waha‐Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: An update 2019. Eur Heart J 2019;40:2671–2683. 10.1093/eurheartj/ehz363 PubMed DOI

Thayer KL, Zweck E, Ayouty M, Garan AR, Hernandez‐Montfort J, Mahr C, PubMed DOI PMC

Schrage B, Dabboura S, Yan I, Hilal R, Neumann JT, Sörensen NA, PubMed DOI

Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, PubMed DOI

Jentzer JC, van Diepen S, Barsness GW, Henry TD, Menon V, Rihal CS, PubMed DOI

Schrage B, Sundermeyer J, Beer BN, Bertoldi L, Bernhardt A, Blankenberg S, PubMed DOI

Ghionzoli N, Sciaccaluga C, Mandoli G, Vergaro G, Gentile F, D'Ascenzi F, PubMed DOI PMC

Rewa O, Bagshaw SM. Acute kidney injury – epidemiology, outcomes and economics. Nat Rev Nephrol 2014;10:193–207. 10.1038/nrneph.2013.282 PubMed DOI

Zhang J, Bottiglieri T, McCullough PA. The central role of endothelial dysfunction in cardiorenal syndrome. Cardiorenal Med 2017;7:104–117. 10.1159/000452283 PubMed DOI PMC

Damman K, Testani JM. The kidney in heart failure: An update. Eur Heart J 2015;36:1437–1444. 10.1093/eurheartj/ehv010 PubMed DOI PMC

Tarvasmäki T, Haapio M, Mebazaa A, Sionis A, Silva‐Cardoso J, Tolppanen H, PubMed DOI

Koreny M, Karth GD, Geppert A, Neunteufl T, Priglinger U, Heinz G, PubMed DOI

Pickering JW, Blunt IRH, Than MP. Acute kidney injury and mortality prognosis in acute coronary syndrome patients: A meta‐analysis. Nephrol Ther 2018;23:237–246. 10.1111/NEP.12984 PubMed DOI

Uzendu A, Kennedy K, Chertow G, Amin AP, Giri JS, Rymer JA, PubMed DOI PMC

Dalia T, Pothuru S, Chan WC, Mehta H, Goyal A, Farhoud H, PubMed DOI PMC

Sheikh O, Nguyen T, Bansal S, Prasad A. Acute kidney injury in cardiogenic shock: A comprehensive review. Catheter Cardiovasc Interv 2021;98:E91–E105. 10.1002/ccd.29141 PubMed DOI

Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, PubMed DOI PMC

Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv, 2019; 94(1): 29–37. 10.1002/ccd.28329 PubMed DOI

Kramer HJ, Jaar BG, Choi MJ, Palevsky PM, Vassalotti JA, Rocco MV. An endorsement of the removal of race from GFR estimation equations: A position statement from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Am J Kidney Dis 2022;80:691–696. 10.1053/j.ajkd.2022.08.004 PubMed DOI

Inker LA Eneanya ND Coresh J Tighiouart H Wang D Sang Y, PubMed DOI PMC

Zweck E, Thayer KL, Helgestad OKL, Kanwar M, Ayouty M, Garan AR, PubMed DOI PMC

Kapur NK, Kanwar M, Sinha SS, Thayer KL, Garan AR, Hernandez‐Montfort J, PubMed DOI

Beer BN, Jentzer JC, Weimann J, Dabboura S, Yan I, Sundermeyer J, PubMed DOI

Kanwar MK, Billia F, Randhawa V, Cowger JA, Barnett CM, Chih S, PubMed DOI

Padkins M, Breen T, Van Diepen S, Barsness G, Kashani K, Jentzer JC. Incidence and outcomes of acute kidney injury stratified by cardiogenic shock severity. Catheter Cardiovasc Interv 2021;98:330–340. 10.1002/ccd.29692 PubMed DOI

Fuernau G, Poenisch C, Eitel I, Denks D, de Waha S, Pöss J, PubMed DOI

Marenzi G, Assanelli E, Campodonico J, de Metrio M, Lauri G, Marana I, PubMed DOI

Harjola VP, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, PubMed DOI

Rangaswami J, Bhalla V, Blair JEA, Chang TI, Costa S, Lentine KL, PubMed DOI

Jentzer JC, Bihorac A, Brusca SB, del Rio‐Pertuz G, Kashani K, Kazory A, PubMed DOI PMC

Metra M, Nodari S, Parrinello G, Bordonali T, Bugatti S, Danesi R, PubMed DOI

Patsalis N, Kreutz J, Chatzis G, Syntila S, Griewing S, Pirlet‐Grant C, PubMed DOI PMC

Lauridsen MD, Gammelager H, Schmidt M, Rasmussen TB, Shaw RE, Bøtker HE, PubMed DOI PMC

Hedges SJ, Dehoney SB, Hooper JS, Amanzadeh J, Busti AJ. Evidence‐based treatment recommendations for uremic bleeding. Nat Clin Pract Nephrol 2007;3:138–153. 10.1038/ncpneph0421 PubMed DOI

Prowle JR, Liu YL, Licari E, Bagshaw SM, Egi M, Haase M, PubMed DOI PMC

Hanberg JS, Sury K, Perry Wilson F, Wilson FP, Brisco MA, Ahmad T, PubMed DOI PMC

Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, PubMed DOI PMC

Roman‐Pognuz E, Elmer J, Rittenberger JC, Guyette FX, Berlot G, De Rosa S, PubMed DOI PMC