Impact of renal artery stenosis on acute kidney injury and outcomes after heart failure hospitalization

Introduction

Renal artery stenosis (RAS) and heart failure (HF) are significant causes of morbidity and mortality in the United States. Heart failure exacerbations alone are responsible for almost one million hospitalizations in the United States each year.

Multiple studies have shown patients with HF may have concomitant RAS, however most of these studies included subjects from outpatient heart failure clinics. ^, The management of RAS among hypertensive patients was assessed in the CORAL trial, ^, however management of RAS in subjects hospitalized with acute HF remains controversial. The interconnection between the heart and kidneys is well known. Previous studies have demonstrated that chronic kidney disease (CKD) and worsening renal function are powerful predictors of adverse outcomes in HF patients. Increased central venous pressure as a result of acute HF is also a well-documented predictor of worsening renal function. Renin-angiotensin-aldosterone system antagonists are mainstays of HF treatment and there are concerns about the safety and tolerability of these medications in subjects with RAS. Furthermore, withdrawal of ACE-I/ARB during acute HF hospitalization is associated with adverse outcomes

and it is not known if the presence of RAS is associated with withdrawal of heart failure medications during acute HF hospitalization. Lastly, RAS and HF both increase in prevalence with increasing age and are likely to coexist in elderly HF patients with significant atherosclerotic cardiovascular diseases such as CAD, PAD, or cerebrovascular disease.

AKI is also a common occurrence during acute HF hospitalization.

Although the significance of rising creatinine during treatment of acute HF has been debated, AKI during treatment of acute HF remains a common issue and often limits utilization of appropriate heart failure medical therapies. It is not known whether patients with RAS are more susceptible to AKI during HF hospitalization. Long-term outcomes after HF hospitalization among subjects with concomitant RAS are also under-studied. To address these issues, we performed a retrospective cohort study of subjects with acute HF hospitalization who also had a diagnostic study for RAS.