Drug Related Factors Of Acute Kidney Injury In Hospitalized Patients With Heart Failure

Objective:Acute kidney injury(AKI)in hospitalized patients with Heart failure(HF)is a common problem,leading to a poor prognosis and increased medical costs,and has become a major global health problem.Currently,there is a lack of research on the exact etiology of AKI in HF inpatients with no evidence of chronic kidney disease,especially drug factors.The purpose of this study was to investigate the relationship between the drugs used during the hospitalization of HF patients and new-onset AKI.Methods:From the data of all newly diagnosed HF patients admitted to the Department of Cardiology of Northern Jiangsu People’s Hospital from January 2019 to December 2019,a total of 230 patients were included according to certain admission and discharge criteria.Obtain the patient’s diagnostic information and medication information from the medical record system.Potential risk factors for AKI in HF patients and the relationship between the use of angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blockers,diuretics and AKI were retrospectively analyzed.Basic information,medical history,physical examination,laboratory and imaging examination,diagnosis and medication data were collected from patients’medical records,including Scr within 7 days of admission and N-terminal probrain natriuretic peptide(NT-pro BNP),red blood cell count(RBC),hemoglobin(HGB),white blood cell count(WBC),platelet count(PLT),alanine transaminase(ALT),aspartate aminotransferase(AST),serum urea(SU)within 24 hours after admission,left ventricular ejection fraction(LVEF),angiotensin converting enzyme inhibitor(ACEI),angiotensinⅡreceptor blocker(ARB),angiotensin receptor-neprilysin inhibitor(ANRI),β-blockers,spironolactone,furosemide,contrast agents(non-ionic type),penicillin antibiotics(piperacillin tazobactam),cephalosporins antibiotics(cefazolin and ceftriaxone),vasodilators(sodium nitroprusside,nitroglycerin),etc.According to KDIGO(kidney disease:improving global outcomes)criteria,the study population was divided into two groups:HF with AKI(HFw AKI)and HF without AKI(HFwo AKI).The stratified chi-square analysis was used to analyze the relationship between the daily dose of furosemide and the incidence of AKI in patients with different NYHA grade.Multivariate logistic regression was used to analyze the drug-related factors of AKI in hospitalized HF patients.Results:1.Non-pharmacological univariate analysis showed significant differences in NYHA grade,NT-pro BNP,LVEF,RBC,and HGB at admission compared with the HFwo AKI group(P=0.025,0.027,0.026,<0.001,and<0.001,respectively).2.Univariate analysis showed that compared with the HFwo AKI group,a higher proportion of contrast agents were used in the HFw AKI group(P=0.002).The HFw AKI group received a higher daily dose of furosemide(P=0.011),with a 2.1-fold increased risk of AKI when the dose reached 80mg/d(OR=3.111,P=0.003).3.Multivariate stratified chi-square analysis showed that 80mg/d furosemide was associated with a 2.4-fold(OR=3.400,P=0.039)and 2.9-fold(OR=3.896,P=0.010)increased risk of AKI in patients with NYHA grade III and IV,respectively.4.Multiple Logistic regression analysis showed that the HFw AKI group had worse NYHA grade on admission(OR=3.977,P=0.003)and higher complication rate of anemia(OR=3.562,P=0.020).The use of 80mg/d furosemide(OR=6.238,P<0.001)or contrast medium(OR=7.334,P<0.001)during hospitalization in HF patients was a risk factor for AKI.Model Goodness of Fit:Pearsonχ~2=6.663,df=8,P=0.573.Conclusions:1.Severe cardiac insufficiency and anemia are initial risk factors for AKI.2.The use of contrast agents in HF inpatients is an independent risk factor for AKI.3.High-dose furosemide significantly increases the risk of HF complicated with AKI.