Kidney Tubular Biomarkers Predict Risk of Death and Heart Failure Readmission in Acute Heart Failure

Kidney dysfunction, defined by measures of glomerular health, in patients hospitalized with acute heart failure (HF) is associated with death and HF readmission. We aimed to determine if kidney tubule damage and dysfunction are associated with these outcomes in acute HF. In AKINESIS (Acute Kidney In...

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Published in:Journal of the American Heart Association Vol. 14; no. 18; p. e042880
Main Authors: Wettersten, Nicholas, Duff, Stephen, Horiuchi, Yu, van Veldhuisen, Dirk J., Estrella, Michelle M., Shlipak, Michael G., Maisel, Alan, Murray, Patrick T., Ix, Joachim H.
Format: Journal Article
Language:English
Published: England Wiley 16.09.2025
Subjects:
Acute Disease
Acute Kidney Injury - diagnosis
Acute Kidney Injury - mortality
Acute Kidney Injury - physiopathology
Acute Kidney Injury - urine
Aged
Aged, 80 and over
biomarkers
Biomarkers - blood
Biomarkers - urine
Case-Control Studies
death
Female
Glomerular Filtration Rate
Heart Failure - complications
Heart Failure - diagnosis
Heart Failure - mortality
Heart Failure - physiopathology
Heart Failure - therapy
Heart Failure - urine
heart failure readmission
Humans
Insulin-Like Growth Factor Binding Proteins - urine
kidney tubule health
Kidney Tubules - metabolism
Kidney Tubules - physiopathology
Lipocalin-2 - urine
Male
Middle Aged
Patient Readmission - statistics & numerical data
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors
risk prediction
Tissue Inhibitor of Metalloproteinase-2 - urine
kidney tubule health
death
heart failure readmission
biomarkers
risk prediction
ISSN:2047-9980, 2047-9980
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Summary:Kidney dysfunction, defined by measures of glomerular health, in patients hospitalized with acute heart failure (HF) is associated with death and HF readmission. We aimed to determine if kidney tubule damage and dysfunction are associated with these outcomes in acute HF. In AKINESIS (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin [NGAL] Evaluation of Symptomatic Heart Failure Study), 218 individuals admitted with acute HF experiencing acute kidney injury were matched with 218 individuals without acute kidney injury. Fourteen urine tubular damage and dysfunction biomarkers were measured at hospital admission in this case-control cohort. Associations between biomarkers and the composite outcome of death or HF readmission, death alone, and HF readmission alone were evaluated adjusting for confounders including kidney and cardiac biomarkers. The mean age was 71±12 years, 64% were men, and mean admission estimated glomerular filtration rate was 55±23 mL/min per 1.73 m . There were 156 deaths or HF readmissions, 87 deaths, and 92 HF readmissions over 1 year. Each 2-fold higher level of IGFBP-7 (insulin-like growth factor binding protein-7), IGFBP-7*TIMP-2 (tissue inhibitor of metalloproteinases-2) product, KIM-1 (kidney injury molecule-1), and MCP-1 (monocyte chemoattractant protein-1) was associated with a 1.36 (95% CI, 1.13-1.64), 1.08 (95% CI, 1.01-1.14), 1.12 (95% CI, 1.02-1.24), and 1.18 (95% CI, 1.03-1.34) higher risk of death or HF readmission, respectively. IGFBP-7 was associated with death alone, whereas MCP-1 and CCL-14 (C-C motif chemokine ligand-14) were associated with HF readmission alone. Biomarkers of kidney tubular health are associated with risk of death and HF readmission among people admitted with acute HF independent of measures of glomerular function and cardiac risk.
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ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.125.042880