Ohne Titel

Decompensated heart failure; Troponin I; Hospitalization

It is known that acute kidney injury (AKI) is one of the most

frequent complications during hospitalization of a patient,

with detrimental effects on his prognosis in a variety of clinical scenarios including abdominal aortic aneurysm repair surgery , coronary angiography , cardiopulmonary bypass surgery , and critically ill patients in the intensive care unit

The incidence of AKI in AMI patients as published in the

medical literature fluctuates from 5.2 to 59%

applied studies

a national sample of patients with AMI admitted to 383 hospitals in

the United States. The study included 59,970 patients hospitalized with AMI

concluded that for the period of July 2008 to

September 2009 the incidence of ARI was 16.1%.

Incidence of AKI (16.5%) for the period of time between 2008 and

2012 including 76,500 patients with AMI from 581 hospitals

In the largest observational study that includes 147,007 seniors.

Medicare patients admitted by IAM since January 1994

until February 1996 as part of the Cooperative

Cardiovascular project, an incidence rate of ARI of 19.4%

It was reported

The patients who undergo urgent coronary artery bypass

grafting (CABG) constitute a particular category of AMI patients rather susceptible to AKI. In the HORIZONS-AMI and

ACUITY trials

the patients who underwent percutaneous coronary intervention (PCI) had 16.1% frequency rate of AKI

in a study in which AMI patients were treated

with CABG

the incident rate was nearly doubled (31.9%)

Other possible predictors of AKI development in patients with AMI are hemodynamic instability and ejection

fraction levels

Short-Term and Long-Term Prognosis

AMI patients complicated with AKI have higher in-hospital

mortality.

in-hospital mortality is higher in patients who

develop AKI with reported hazard ratios (HR) from 2 to over

Preventive Strategies

The medical community in response to the frequent incidence

of AKI in AMI patients and the detrimental impact on their

prognosis applied numerous efforts in order to tackle this inhospital complication.

The current guidelines

issued by the European Society of Cardiology, KDIGO, and

other societies contain the following recommendations for

prevention of contrast-induced nephropathy

should be prevent for patients when life-threatening changes

in fluid, electrolyte, and acid-base balance exist

hyperkalemia, metabolic acidosis, symptoms or complications of uremia (for example, pericarditis or encephalopathy),

fluid overload/pulmonary edema not responding to standard

medical treatment

The main guidance is to consider the

broader clinical context, the presence of conditions that can

be modified with RRT, and trends of laboratory tests—rather

than single urea and creatinine thresholds alone—when making the decision to start RRT.

besides avoiding cardiac overload