Kidney360. 2026 Jul 1. doi: 10.34067/KID.0000001263. Online ahead of print.
ABSTRACT
BACKGROUND: Acute heart failure (heart failure) is a common cause of acute kidney injury (AKI) in hospitalized patients, yet it remains unclear why some patients develop AKI while others with similar clinical courses do not. An important aspect of kidney function, lower tubule secretion has been associated with higher risk of AKI. In this study, we examined whether tubular secretion measured during periods of stable health is associated with the future risk of AKI years later during hospitalization for acute heart failure.
METHODS: We studied community-dwelling adults over 45 years in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. We identified all individuals who experienced acute heart failure admission. Using daily creatinine values we identified heart failure hospitalizations with AKI (rise in serum creatinine ≥0.3 mg/dL) and without AKI. We selected 400 with AKI and 419 frequency matched non-AKI controls. We measured secretion using blood and urine obtained at REGARDS baseline (median 5.6 [IQR 2.6, 9.4] years before acute heart failure hospitalization). We calculated a summary secretion score incorporating urine-to-plasma ratios of 11 endogenous secretion markers measured in paired urine and plasma samples. We used logistic regression to examine the association of the summary secretion score with future AKI following acute heart failure, adjusting for demographic and clinical variables including estimated glomerular filtration rate (eGFR) and albuminuria.
RESULTS: Except for higher albuminuria and lower eGFR, participants with and without AKI exhibited similar baseline characteristics and secretion score. In multivariable models, secretion score was not associated with adjusted odds of AKI (adjusted OR 1.31 per two-fold higher secretion score; 95% CI 0.48, 3.57).
CONCLUSIONS: In this cohort of community-based adults, we did not detect associations between measures of tubular secretion at stable baseline and future AKI during acute heart failure admissions.
PMID:42384455 | DOI:10.34067/KID.0000001263