J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 16, Number 6, June 2024, pages 302-309

Clinically Evident Cardiopulmonary Congestion Does Not Significantly Impact the Prognosis of Patients With Septic Acute Kidney Injury

Figure 1. Graphical summary of all three endpoints. The P-values have been listed in Table 2. AKI: acute kidney injury; KRT: kidney replacement therapy; ROKF: recovery of kidney function.

**Table 1.** Characteristics of All Included Patients
Variable	All patients	No congestion	Congestion
AKI: acute kidney injury; BUN: blood urea nitrogen; CAD: coronary artery disease; CHF: chronic heart failure; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; DOIT: duration of in-hospital treatment; KRT: kidney replacement therapy; ROKF: recovery of kidney function; SD: standard deviation.
Age (± SD) (years)	75.4 ± 11.6	70.4 ± 3	76.7 ± 1.1
Female gender (%)	42.2	40.9	42.5
DOIT (± SD) (days)	18 ± 16	21.5 ± 5.7	17 ± 1.2
AKI stage (KDIGO) I, II, III (%)	12.7, 30.4, 56.9	9.1, 36.4, 54.5	13.8, 28.7, 57.5
Survival (%)	47.1	50	46.2
KRT (%)	17.6	18.2	17.5
ROKF (%)	53.9	54.5	53.8
Sepsis focus
Urinary tract (%)	29.4	36.4	27.5
Respiratory system (%)	27.5	18.2	30
Abdominal (%)	24.5	22.7	25
Other (%)	18.6	22.7	17.5
Vasopressor therapy (%)	47.1	54.5	45
Respiratory support (%)	48	36.4	51.2
Morbidities
Pre-existing CKD (%)	42.6	31.8	45.6
Arterial hypertension (%)	84.3	86.4	83.8
Diabetes mellitus (%)	50	45.5	51.2
Obesity (%)	34.3	18.2	38.8
Smoking (%)	11.7	22.7	8.8
CAD (%)	30.4	27.3	31.2
CHF (%)	40.2	27.3	43.8
COPD (%)	19.6	13.6	21.2
History of neoplasia (%)	40.2	59.1	35
Laboratory findings (all in mean ± SD)
Baseline serum creatinine (µmol/L)	294.3 ± 245.5	354.6 ± 55.2	277.5 ± 27
Peak serum creatinine (µmol/L)	393.6 ± 217.6	436.1 ± 47.1	381.9 ± 24.2
Serum creatinine at discharge (µmol/L)	240.6 ± 157.5	246.8 ± 37.6	239 ± 17.4
Baseline serum BUN (mmol/L)	24.8 ± 22.3	40.7 ± 14.2	22 ± 2.8
Peak serum BUN (mmol/L)	28.1 ± 17.1	34.1 ± 7.1	26.9 ± 1.7
Serum BUN at discharge (mmol/L)	21.2 ± 12.6	21.1 ± 3.2	21.2 ± 2.1
Baseline serum potassium (mmol/L)	4.6 ± 1.2	5 ± 0.4	4.5 ± 0.1
Peak serum potassium (mmol/L)	5.2 ± 1	5.4 ± 0.3	5.1 ± 0.1
Serum potassium at discharge (mmol/L)	4.4 ± 0.8	4.5 ± 0.2	4.4 ± 0.08
Baseline serum sodium (mmol/L)	136.7 ± 7.9	136.9 ± 2.3	136.7 ± 0.8
Minimum serum sodium (mmol/L)	134.2 ± 7.3	133.4 ± 1.9	134.5 ± 0.7
Serum sodium at discharge (mmol/L)	141.5 ± 8.6	140.6 ± 1.6	141.8 ± 0.9
Baseline CRP (mg/L)	125.6 ± 127.9	191.2 ± 39.7	108.1 ± 11.6
Peak CRP (mg/L)	259.1 ± 125	289.2 ± 31.2	250.8 ± 13.2
CRP at discharge (mg/L)	127.8 ± 120.6	135.1 ± 30.4	125.8 ± 12.8

Table 1. Characteristics of All Included Patients

Variable

All patients

No congestion

Congestion

AKI: acute kidney injury; BUN: blood urea nitrogen; CAD: coronary artery disease; CHF: chronic heart failure; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; DOIT: duration of in-hospital treatment; KRT: kidney replacement therapy; ROKF: recovery of kidney function; SD: standard deviation.

Age (± SD) (years)

75.4 ± 11.6

70.4 ± 3

76.7 ± 1.1

Female gender (%)

42.2

40.9

42.5

DOIT (± SD) (days)

18 ± 16

21.5 ± 5.7

17 ± 1.2

AKI stage (KDIGO) I, II, III (%)

12.7, 30.4, 56.9

9.1, 36.4, 54.5

13.8, 28.7, 57.5

Survival (%)

47.1

46.2

KRT (%)

17.6

18.2

17.5

ROKF (%)

53.9

54.5

53.8

Sepsis focus

Urinary tract (%)

29.4

36.4

27.5

Respiratory system (%)

27.5

18.2

Abdominal (%)

24.5

22.7

Other (%)

18.6

22.7

17.5

Vasopressor therapy (%)

47.1

54.5

Respiratory support (%)

36.4

51.2

Morbidities

Pre-existing CKD (%)

42.6

31.8

45.6

Arterial hypertension (%)

84.3

86.4

83.8

Diabetes mellitus (%)

45.5

51.2

Obesity (%)

34.3

18.2

38.8

Smoking (%)

11.7

22.7

8.8

CAD (%)

30.4

27.3

31.2

CHF (%)

40.2

27.3

43.8

COPD (%)

19.6

13.6

21.2

History of neoplasia (%)

40.2

59.1

Laboratory findings (all in mean ± SD)

Baseline serum creatinine (µmol/L)

294.3 ± 245.5

354.6 ± 55.2

277.5 ± 27

Peak serum creatinine (µmol/L)

393.6 ± 217.6

436.1 ± 47.1

381.9 ± 24.2

Serum creatinine at discharge (µmol/L)

240.6 ± 157.5

246.8 ± 37.6

239 ± 17.4

Baseline serum BUN (mmol/L)

24.8 ± 22.3

40.7 ± 14.2

22 ± 2.8

Peak serum BUN (mmol/L)

28.1 ± 17.1

34.1 ± 7.1

26.9 ± 1.7

Serum BUN at discharge (mmol/L)

21.2 ± 12.6

21.1 ± 3.2

21.2 ± 2.1

Baseline serum potassium (mmol/L)

4.6 ± 1.2

5 ± 0.4

4.5 ± 0.1

Peak serum potassium (mmol/L)

5.2 ± 1

5.4 ± 0.3

5.1 ± 0.1

Serum potassium at discharge (mmol/L)

4.4 ± 0.8

4.5 ± 0.2

4.4 ± 0.08

Baseline serum sodium (mmol/L)

136.7 ± 7.9

136.9 ± 2.3

136.7 ± 0.8

Minimum serum sodium (mmol/L)

134.2 ± 7.3

133.4 ± 1.9

134.5 ± 0.7

Serum sodium at discharge (mmol/L)

141.5 ± 8.6

140.6 ± 1.6

141.8 ± 0.9

Baseline CRP (mg/L)

125.6 ± 127.9

191.2 ± 39.7

108.1 ± 11.6

Peak CRP (mg/L)

259.1 ± 125

289.2 ± 31.2

250.8 ± 13.2

CRP at discharge (mg/L)

127.8 ± 120.6

135.1 ± 30.4

125.8 ± 12.8

**Table 2.** Endpoint Analysis
Endpoint	No congestion	Congestion	P-value
The three endpoints survival, KRT and ROKF were not reached more frequently in patients with cardiovascular congestion. KRT: kidney replacement therapy; ROKF: recovery of kidney function.
Survival (%)	50	46.2	0.75
KRT (%)	18.2	17.5	0.94
ROKF (%)	54.5	53.8	0.94

Table 2. Endpoint Analysis

Endpoint

No congestion

Congestion

P-value

The three endpoints survival, KRT and ROKF were not reached more frequently in patients with cardiovascular congestion. KRT: kidney replacement therapy; ROKF: recovery of kidney function.

Survival (%)

46.2

0.75

KRT (%)

18.2

17.5

0.94

ROKF (%)

54.5

53.8

0.94

**Table 3.** Risk Factor Analysis
Variable	Survival, yes/no/P-value	KRT, yes/no/P-value	ROKF, yes/no/P-value
In all analyses, differences were always calculated between patients that reached the endpoint (survival, KRT, ROKF) and those who did not. AKI: acute kidney injury; BUN: blood urea nitrogen; CAD: coronary artery disease; CHF: chronic heart failure; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; DOIT: duration of in-hospital treatment; KRT: kidney replacement therapy; ROKF: recovery of kidney function; SD: standard deviation
Age (± SD) (years)	73.8 ± 1.9/76.8 ± 1.3/0.19	70 ± 2.6/76.5 ± 1.2/0.017	75.2 ± 1.7/75.6 ± 1.5/0.68
Femel gender (%)	45.8/38.9/0.48	44.4/41.7/0.82	41.8/42.6/0.94
AKI stage (KDIGO) I, II, III (%)	16.7, 43.8, 39.6/9.3, 18.5, 72.2/0.004	22.2, 16.7, 61.1/10.7, 33.3, 56/0.22	20, 43.6, 36.4/4.3, 14.9, 80.9/< 0.001
DOIT (± SD) (days)	23 ± 2.6/13.5 ± 1.6/0.003	24.6 ± 6.6/16.5 ± 1.2/0.43	22.1 ± 2.4/13.2 ± 1.5/< 0.001
Survival (%)	NA	44.4/47.6/0.8	80/8.5/< 0.001
KRT (%)	16.7/18.5/0.87	NA	16.4/19.1/0.71
ROKF (%)	91.7/20.4/< 0.001	50/54.8/0.71	NA
Vasopressor therapy (%)	35.4/57.4/0.026	61.1/44/0.18	41.8/53.2/0.25
Respiratory support (%)	41.7/53.7/0.22	61.1/45.2/0.22	49.1/46.8/0.81
Morbidities
Arterial hypertension (%)	89.6/79.6/0.16	88.9/83.3/0.55	87.3/80.9/0.37
CAD (%)	29.2/31.5/0.8	16.7/33.3/0.16	36.4/23.4/0.15
CHF (%)	43.8/37/0.49	38.9/40.5/0.9	45.5/34/0.24
COPD (%)	16.7/22.2/0.48	11.1/21.4/0.31	23.6/14.9/0.26
Obesity (%)	41.7/27.8/0.14	38.9/33.3/0.65	38.2/29.8/0.37
Diabetes mellitus (%)	54.2/46.3/0.42	38.9/52.4/0.29	58.2/40.4/0.07
Smoking (%)	14.6/9.3/0.4	5.6/13.1/0.36	16.4/6.7/0.11
History of neoplasia (%)	41.7/38.9/0.77	44.4/39.3/0.68	38.2/42.6/0.65
Laboratory findings (all in mean ± SD)
Baseline serum creatinine (µmol/L)	326 ± 41.2/266.7 ± 28.1/0.38	507.2 ± 74.7/248.1 ± 22.1/< 0.001	308.7 ± 33.1/277.7 ± 36.4/0.32
Peak serum creatinine (µmol/L)	397.1 ± 37.2/390.5 ± 24/0.34	636.6 ± 56.8/341.5 ± 18.9/< 0.001	378.4 ± 30.1/411.4 ± 30.8/0.12
Serum creatinine at discharge (µmol/L)	173.5 ± 17.8/301.3 ± 22.4/< 0.001	375.6 ± 44.9/214.6 ± 15.3/< 0.001	185.6 ± 19.7/306.6 ± 21.9/< 0.001
Baseline serum BUN (mmol/L)	28 ± 6.2/22.1 ± 3/0.89	34.2 ± 7.2/20.3 ± 3.2/0.02	24.9 ± 5/24.7 ± 3.6/0.46
Peak serum BUN (mmol/L)	25.3 ± 2.8/30.8 ± 2.3/0.016	37.5 ± 5.7/25.6 ± 1.6/0.02	27.3 ± 2.7/29.1 ± 2.3/0.15
Serum BUN at discharge (mmol/L)	9.7 ± 1.8/25.4 ± 1.9/< 0.001	20.8 ± 3.2/21.4 ± 2.1/0.8	15 ± 2.5/25.9 ± 2.1/0.001
Baseline serum potassium (mmol/L)	4.8 ± 0.2/4.5 ± 0.1/0.71	5.4 ± 0.4/4.4 ± 0.1/0.05	4.8 ± 0.2/4.4 ± 0.1/0.2
Peak serum potassium (mmol/L)	5 ± 0.1/5.3 ± 0.1/0.008	5.9 ± 0.3/5 ± 0.1/0.01	5.1 ± 0.1/5.3 ± 0.1/0.06
Serum potassium at discharge (mmol/L)	4 ± 0.07/4.8 ± 0.1/< 0.001	4.7 ± 0.2/4.4 ± 0.08/0.16	4.2 ± 0.08/4.7 ± 0.1/0.001
Baseline serum sodium (mmol/L)	134 ± 1/139 ± 1/0.003	135.7 ± 1.7/136.9 ± 0.9/0.61	134.8 ± 0.9/139 ± 1.2/0.03
Minimum serum sodium (mmol/L)	132.1 ± 0.9/136.1 ± 1/0.024	133 ± 1.2 ± 134.5 ± 0.8/0.45	132.7 ± 0.9/136 ± 1/0.02
Serum sodium at discharge (mmol/L)	139.8 ± 0.8/143 ± 1.4/0.35	138.5 ± 1/142.2 ± 1/0.25	139.9 ± 0.8/143.4 ± 1.5/0.19
Baseline CRP (mg/L)	134.9 ± 16.9/117.6 ± 18.8/0.17	134.6 ± 24.9/123.6 ± 14.6/0.25	121.3 ± 15.5/130.5 ± 20.9/0.95
Peak CRP (mg/L)	254 ± 16.4/263.5 ± 18.3/0.95	253.3 ± 30.3/260.3 ± 13.6/0.74	251.2 ± 15/268.3 ± 20.3/0.82
CRP at discharge (mg/L)	56.1 ± 7.1/190.3 ± 17.6/< 0.001	111.7 ± 22.8/131.3 ± 13.7/0.69	76.6 ± 9.7/186.7 ± 20.1/< 0.001

Table 3. Risk Factor Analysis

Variable

Survival, yes/no/P-value

KRT, yes/no/P-value

ROKF, yes/no/P-value

In all analyses, differences were always calculated between patients that reached the endpoint (survival, KRT, ROKF) and those who did not. AKI: acute kidney injury; BUN: blood urea nitrogen; CAD: coronary artery disease; CHF: chronic heart failure; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CRP: C-reactive protein; DOIT: duration of in-hospital treatment; KRT: kidney replacement therapy; ROKF: recovery of kidney function; SD: standard deviation

Age (± SD) (years)

73.8 ± 1.9/76.8 ± 1.3/0.19

70 ± 2.6/76.5 ± 1.2/0.017

75.2 ± 1.7/75.6 ± 1.5/0.68

Femel gender (%)

45.8/38.9/0.48

44.4/41.7/0.82

41.8/42.6/0.94

AKI stage (KDIGO) I, II, III (%)

16.7, 43.8, 39.6/9.3, 18.5, 72.2/0.004

22.2, 16.7, 61.1/10.7, 33.3, 56/0.22

20, 43.6, 36.4/4.3, 14.9, 80.9/< 0.001

DOIT (± SD) (days)

23 ± 2.6/13.5 ± 1.6/0.003

24.6 ± 6.6/16.5 ± 1.2/0.43

22.1 ± 2.4/13.2 ± 1.5/< 0.001

Survival (%)

44.4/47.6/0.8

80/8.5/< 0.001

KRT (%)

16.7/18.5/0.87

16.4/19.1/0.71

ROKF (%)

91.7/20.4/< 0.001

50/54.8/0.71

Vasopressor therapy (%)

35.4/57.4/0.026

61.1/44/0.18

41.8/53.2/0.25

Respiratory support (%)

41.7/53.7/0.22

61.1/45.2/0.22

49.1/46.8/0.81

Morbidities

Arterial hypertension (%)

89.6/79.6/0.16

88.9/83.3/0.55

87.3/80.9/0.37

CAD (%)

29.2/31.5/0.8

16.7/33.3/0.16

36.4/23.4/0.15

CHF (%)

43.8/37/0.49

38.9/40.5/0.9

45.5/34/0.24

COPD (%)

16.7/22.2/0.48

11.1/21.4/0.31

23.6/14.9/0.26

Obesity (%)

41.7/27.8/0.14

38.9/33.3/0.65

38.2/29.8/0.37

Diabetes mellitus (%)

54.2/46.3/0.42

38.9/52.4/0.29

58.2/40.4/0.07

Smoking (%)

14.6/9.3/0.4

5.6/13.1/0.36

16.4/6.7/0.11

History of neoplasia (%)

41.7/38.9/0.77

44.4/39.3/0.68

38.2/42.6/0.65

Laboratory findings (all in mean ± SD)

Baseline serum creatinine (µmol/L)

326 ± 41.2/266.7 ± 28.1/0.38

507.2 ± 74.7/248.1 ± 22.1/< 0.001

308.7 ± 33.1/277.7 ± 36.4/0.32

Peak serum creatinine (µmol/L)

397.1 ± 37.2/390.5 ± 24/0.34

636.6 ± 56.8/341.5 ± 18.9/< 0.001

378.4 ± 30.1/411.4 ± 30.8/0.12

Serum creatinine at discharge (µmol/L)

173.5 ± 17.8/301.3 ± 22.4/< 0.001

375.6 ± 44.9/214.6 ± 15.3/< 0.001

185.6 ± 19.7/306.6 ± 21.9/< 0.001

Baseline serum BUN (mmol/L)

28 ± 6.2/22.1 ± 3/0.89

34.2 ± 7.2/20.3 ± 3.2/0.02

24.9 ± 5/24.7 ± 3.6/0.46

Peak serum BUN (mmol/L)

25.3 ± 2.8/30.8 ± 2.3/0.016

37.5 ± 5.7/25.6 ± 1.6/0.02

27.3 ± 2.7/29.1 ± 2.3/0.15

Serum BUN at discharge (mmol/L)

9.7 ± 1.8/25.4 ± 1.9/< 0.001

20.8 ± 3.2/21.4 ± 2.1/0.8

15 ± 2.5/25.9 ± 2.1/0.001

Baseline serum potassium (mmol/L)

4.8 ± 0.2/4.5 ± 0.1/0.71

5.4 ± 0.4/4.4 ± 0.1/0.05

4.8 ± 0.2/4.4 ± 0.1/0.2

Peak serum potassium (mmol/L)

5 ± 0.1/5.3 ± 0.1/0.008

5.9 ± 0.3/5 ± 0.1/0.01

5.1 ± 0.1/5.3 ± 0.1/0.06

Serum potassium at discharge (mmol/L)

4 ± 0.07/4.8 ± 0.1/< 0.001

4.7 ± 0.2/4.4 ± 0.08/0.16

4.2 ± 0.08/4.7 ± 0.1/0.001

Baseline serum sodium (mmol/L)

134 ± 1/139 ± 1/0.003

135.7 ± 1.7/136.9 ± 0.9/0.61

134.8 ± 0.9/139 ± 1.2/0.03

Minimum serum sodium (mmol/L)

132.1 ± 0.9/136.1 ± 1/0.024

133 ± 1.2 ± 134.5 ± 0.8/0.45

132.7 ± 0.9/136 ± 1/0.02

Serum sodium at discharge (mmol/L)

139.8 ± 0.8/143 ± 1.4/0.35

138.5 ± 1/142.2 ± 1/0.25

139.9 ± 0.8/143.4 ± 1.5/0.19

Baseline CRP (mg/L)

134.9 ± 16.9/117.6 ± 18.8/0.17

134.6 ± 24.9/123.6 ± 14.6/0.25

121.3 ± 15.5/130.5 ± 20.9/0.95

Peak CRP (mg/L)

254 ± 16.4/263.5 ± 18.3/0.95

253.3 ± 30.3/260.3 ± 13.6/0.74

251.2 ± 15/268.3 ± 20.3/0.82

CRP at discharge (mg/L)

56.1 ± 7.1/190.3 ± 17.6/< 0.001

111.7 ± 22.8/131.3 ± 13.7/0.69

76.6 ± 9.7/186.7 ± 20.1/< 0.001