Factors Associated with Early Acute Kidney Injury in Patients with Acute Decompensated Heart Failure: A Retrospective Observational Study in Bandung, Indonesia
Keywords:
Acute decompensated heart failure, Acute kidney injury, NT-proBNP, Associated factors, Renal function
Abstract
Background: Acute Kidney Injury (AKI) frequently complicates Acute Decompensated Heart Failure (ADHF) and is associated with adverse clinical outcomes. Early recognition of patients at higher risk is clinically important, particularly during the first 48 hours of hospitalization when decongestive treatment and renal monitoring are actively adjusted.
Methods: This retrospective observational registry-based study analyzed adult patients hospitalized with ADHF at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from January 2024 to October 2025. Of 279 screened registry records, 148 were included in the final analysis. AKI was defined as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours after admission. Baseline demographic, clinical, echocardiographic, treatment, and laboratory variables were evaluated using bivariate analysis and multivariable logistic regression.
Results: Among 148 included patients, AKI occurred in 67 patients (45.3%). The cohort was predominantly composed of patients with reduced Left Ventricular Ejection Fraction (LVEF), with 145 patients (98.0%) having LVEF <=40%. Admission N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) >5,000 pg/mL was associated with higher odds of early AKI in the adjusted model (Adjusted Odds Ratio [AOR] 2.04; 95% Confidence Interval [CI] 1.02-4.11; p=0.045). Hypertension and high initial furosemide dose showed nonsignificant trends, whereas other demographic and comorbidity variables did not show statistically significant associations in this cohort.
Conclusions: Elevated admission NT-proBNP was associated with early AKI among patients hospitalized with ADHF. However, these findings should be interpreted as exploratory and hypothesis-generating rather than causal or predictive. Validation in larger and more diverse cohorts is required.
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References
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35. Kang J, Park JJ, Cho YJ, et al. Predictors and prognostic value of worsening renal function during admission in HFpEF Versus HFrEF: Data from the KorAHF registry. J Am Heart Assoc. 2018;7(6).
36. Feng S, Janwanishstaporn S, Teerlink JR, et al. Association of left ventricular ejection fraction with worsening renal function in patients with acute heart failure: insights from the RELAX-AHF-2 study. Eur J Heart Fail. 2021;23(1):58-67.
37. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2:1-138.
2. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2022;79(17):e263-e421.
3. Metra M, Cotter G, Gheorghiade M, Dei Cas L, Voors AA. The role of the kidney in heart failure. Eur Heart J. 2012;33(17):2135-42.
4. Tang WHW, Bakitas MA, Cheng XS, et al. Evaluation and Management of Kidney Dysfunction in Advanced Heart Failure: A Scientific Statement from the American Heart Association. Circulation. 2024;150(16):e280-e95.
5. Chahal RS, Chukwu CA, Kalra PR, Kalra PA. Heart failure and acute renal dysfunction in the cardiorenal syndrome. Clin Med (Lond). 2020;20(2):146-50.
6. Banerjee D, Ali MA, Wang AYM, Jha V. Acute kidney injury in acute heart failure-when to worry and when not to worry? Nephrol Dial Transplant. 2025;40(1):10-8.
7. Emmens JE, ter Maaten JM, Matsue Y, et al. Worsening renal function in acute heart failure in the context of diuretic response. Eur J Heart Fail. 2022;24(2):365-74.
8. Ru SC, Lv SB, Li ZJ, et al. Incidence, mortality, and predictors of acute kidney injury in patients with heart failure: a systematic review. ESC Heart Fail. 2023;10(6):3237-49.
9. Rangaswami J, Bhalla V, Blair JEA, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. 2019;139(16):e840-e78.
10. Mullens W, Abrahams Z, Francis GS, et al. Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart Failure. J Am Coll Cardiol. 2009;53(7):589-96.
11. Tamayo-Gutierrez A, Ibrahim HN. The Kidney in Heart Failure: The Role of Venous Congestion. Methodist Debakey Cardiovasc J. 2022;18(4):4-10.
12. Palazzuoli A, Ruocco G, Ronco C, McCullough PA. Loop diuretics in acute heart failure: Beyond the decongestive relief for the kidney. Crit Care. 2015;19:296.
13. Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP. Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation. 2010;122(3):265-72.
14. Kenneally LF, Lorenzo M, Romero-González G, et al. Kidney function changes in acute heart failure: a practical approach to interpretation and management. Clin Kidney J. 2023;16(10):1587-99.
15. Mezgebu Y, Alemu S, Mohamed MA, Shibru H, Hailu W. Acute kidney injury and its associated factors among patients with acute decompensated heart failure admitted to the University of Gondar Hospital, Northwest Ethiopia: a hospital-based cross-sectional study. BMC Nephrol. 2024;25(1).
16. Shetty S, Malik AH, Ali A, Yang YC, Aronow WS, Briasoulis A. Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure - A propensity-score matched analysis. Eur J Intern Med. 2020;79:76-80.
17. Wei J, Zhu J, Zhang J, et al. Aging Impairs Renal Autoregulation in Mice. Hypertension. 2020;75(2):405-12.
18. Loutradis C, Pickup L, Law JP, et al. Acute kidney injury is more common in men than women after accounting for socioeconomic status, ethnicity, alcohol intake and smoking history. Biol Sex Differ. 2021;12(1).
19. Neugarten J, Golestaneh L. Female sex reduces the risk of hospital-associated acute kidney injury: A meta-analysis. BMC Nephrol. 2018;19(1).
20. Jang SY, Yang DH. Prognostic and Therapeutic Implications of Renal Insufficiency in Heart Failure. Int J Heart Fail. 2022;4(2):75-90.
21. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: Challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032-45.
22. Park CH, Kim HW, Park JT, et al. Intrarenal Renin-Angiotensin System Activation Alters Relationship between Systolic Blood Pressure and Progression of Chronic Kidney Disease. Hypertension. 2023;80(5):1024-34.
23. Núñez J, de la Espriella R, Rossignol P, et al. Congestion in heart failure: a circulating biomarker-based perspective. A review from the Biomarkers Working Group of the Heart Failure Association, European Society of Cardiology. Eur J Heart Fail. 2022;24(10):1751-66.
24. Bayes-Genis A, Docherty KF, Petrie MC, et al. Practical algorithms for early diagnosis of heart failure and heart stress using NT-proBNP: A clinical consensus statement from the Heart Failure Association of the ESC. Eur J Heart Fail. 2023;25(11):1891-8.
25. Daniels LB, Maisel AS. Natriuretic Peptides. J Am Coll Cardiol. 2007;50(25):2357-68.
26. Maisel A, Mueller C, Adams K, et al. State of the art: Using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008;10(9):824-39.
27. Lassus JPE, Nieminen MS, Peuhkurinen K, et al. Markers of renal function and acute kidney injury in acute heart failure: definitions and impact on outcomes of the cardiorenal syndrome. Eur Heart J. 2010;31(22):2791-8.
28. Siew ED, Matheny ME, Ikizler TA, et al. Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury. Kidney Int. 2010;77(6):536-42.
29. Bernier-Jean A, Beaubien-Souligny W, Goupil R, et al. Diagnosis and outcomes of acute kidney injury using surrogate and imputation methods for missing preadmission creatinine values. BMC Nephrol. 2017;18(1):141.
30. Cooper DJ, Plewes K, Grigg MJ, et al. An Evaluation of Commonly Used Surrogate Baseline Creatinine Values to Classify AKI During Acute Infection. Kidney Int Rep. 2021;6(3):645-56.
31. Larsen T, See EJ, Holmes N, Bellomo R. Estimating baseline kidney function in hospitalized adults with acute kidney injury. Nephrology (Carlton). 2022;27(7):588-600.
32. Boorsma EM, ter Maaten JM, Voors AA, van Veldhuisen DJ. Renal Compression in Heart Failure: The Renal Tamponade Hypothesis. JACC Heart Fail. 2022;10(3):175-83.
33. Ronco C, Bellasi A, Di Lullo L. Cardiorenal Syndrome: An Overview. Adv Chronic Kidney Dis. 2018;25(5):382-90.
34. Meani P, Pagnoni M, Mondellini GM, Fiorenza S, Brunner-La Rocca HP. Impact of loop diuretic dosage in a population of patients with acute heart failure: a retrospective analysis. Front Cardiovasc Med. 2023;10.
35. Kang J, Park JJ, Cho YJ, et al. Predictors and prognostic value of worsening renal function during admission in HFpEF Versus HFrEF: Data from the KorAHF registry. J Am Heart Assoc. 2018;7(6).
36. Feng S, Janwanishstaporn S, Teerlink JR, et al. Association of left ventricular ejection fraction with worsening renal function in patients with acute heart failure: insights from the RELAX-AHF-2 study. Eur J Heart Fail. 2021;23(1):58-67.
37. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2:1-138.
Published
2026-06-11
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How to Cite
Prameswari, H., Rachmawati, F., Andhika, R., Wijaya, I., Martha, J., & Sukesi, L. (2026). Factors Associated with Early Acute Kidney Injury in Patients with Acute Decompensated Heart Failure: A Retrospective Observational Study in Bandung, Indonesia. Indonesian Journal of Cardiology, 47(2), 132-141. https://doi.org/10.30701/ijc.2187
Section
Clinical Research
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