Heart failure and AKI

It is known that heart disease can cause kidney failure, but not much is known about how kidney failure can cause heart disease. Recently in the United States acute kidney injury (AKI) is on the rise. AKI can lead to chronic kidney disease (CKD), which increases the risk of heart failure. Kidney disease and heart failure are linked in a multifactorial fashion, for example disturbances in sodium handling, sympathetic stimulation, inflammation, up-regulation of the renin-angiotensin-aldosterone system (RAAS), and alterations of mineral metabolism (Bansal et al, 2017). These manifestations also exist in AKI (Bansal et al, 2017). The study used patients who had AKI, and excluded those with preexisting heart conditions. They determined that patients had AKI by using their creatinine laboratory values.

Patients who developed AKI were more likely to be older, be African American, use diuretics or RAAS inhibitors before admission, have diabetes, have hypertension, and sepsis during an hospitalization (Bansal et al, 2017). The body works as a system and it is known that water-retention regulation is way to mange or alter blood pressure. It is no surprise that these patients had blood pressure problems that caused them to take medicine that alters their water-retention. Patients with AKI had nearly a 2-fold increased risk of hospitalized heart failure (Bansal et al, 2017). The majority of these patients within two years of being discharged developed heart disease.

There are many ways to explain the link between AKI and heart failure.  AKI, even after recovery, quickly leads to impaired tubular sodium handling, reduced pressure natriuresis, and salt-sensitive hypertension (Bansal et al, 2017). Natriuresis is the excretion of sodium in urine. AKI has also been demonstrated to up-regulate inflammation in remote organs including the heart; this inflammation associates with apoptosis and functional consequences (Bansal et al, 2017).  Since heart failure and kidney problems are linked it would be beneficial to monitor patients with either closely in order to avoid major health concerns.

Reference

Bansal, N., Matheny, M. E., Greevy, R. A., Eden, S. K., Perkins, A. M., Parr, S. K., . . . Siew, E. D. (2017). Acute Kidney Injury and Risk of Incident Heart Failure Among US Veterans. American Journal of Kidney Diseases. doi:10.1053/j.ajkd.2017.08.027