Kidney injury in patients with heart failure-related cardiogenic shock: Results from an international, multicentre cohort study

Jonas Sundermeyer; Caroline Kellner; Benedikt N Beer; Lisa Besch; Angela Dettling; Letizia Fausta Bertoldi; Stefan Blankenberg; Jeroen Dauw; Dennis Eckner; Ingo Eitel; Tobias Graf; Patrick Horn; Joanna Jozwiak-Nozdrzykowska; Paulus Kirchhof; Stefan Kluge; Axel Linke; Ulf Landmesser; Enzo Lüsebrink; Nicolas Majunke; Norman Mangner; Sven Möbius Winkler; Peter Nordbeck; Martin Orban; Federico Pappalardo; Matthias Pauschinger; Michal Pazdernik; Alastair Proudfoot; Matthew Kelham; Tienush Rassaf; Hermann Reichenspurner; Clemens Scherer; P Christian Schulze; Robert H G Schwinger; Carsten Skurk; Marek Sramko; Guido Tavazzi; Holger Thiele; Luca Villanova; Nuccia Morici; Ephraim B Winzer; Dirk Westermann; Benedikt Schrage

doi:10.1002/ejhf.3701

Kidney injury in patients with heart failure-related cardiogenic shock: Results from an international, multicentre cohort study

Jonas Sundermeyer, Caroline Kellner, Benedikt N Beer, Lisa Besch, Angela Dettling, Letizia Fausta Bertoldi, Stefan Blankenberg, Jeroen Dauw, Dennis Eckner, Ingo Eitel, Tobias Graf, Patrick Horn, Joanna Jozwiak-Nozdrzykowska, Paulus Kirchhof, Stefan Kluge, Axel Linke, Ulf Landmesser, Enzo Lüsebrink, Nicolas Majunke, Norman MangnerSven Möbius Winkler, Peter Nordbeck, Martin Orban, Federico Pappalardo, Matthias Pauschinger, Michal Pazdernik, Alastair Proudfoot, Matthew Kelham, Tienush Rassaf, Hermann Reichenspurner, Clemens Scherer, P Christian Schulze, Robert H G Schwinger, Carsten Skurk, Marek Sramko, Guido Tavazzi, Holger Thiele, Luca Villanova, Nuccia Morici, Ephraim B Winzer, Dirk Westermann, Benedikt Schrage

Medizinische Klinik II

5 Zitate (Scopus)

Abstract

AIMS: Heart failure-related cardiogenic shock (HF-CS) accounts for about half of CS cases, with a paucity of data regarding the role of kidney injury in this subset. This study aims to evaluate patient characteristics and outcome associated with renal function in patients with HF-CS.

METHODS AND RESULTS: In this multicentre, international, retrospective study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation, complications, and 30-day mortality, based on renal function, adjusted logistic and Cox regression models were fitted. Among 1010 HF-CS patients, the median age was 64 (interquartile range [IQR] 52-75) years, with 71.7% being male. Median baseline creatinine was 1.7 (IQR 1.2-2.5) mg/dl, corresponding to an estimated glomerular filtration rate (eGFR) of 41.0 (IQR 25.2-62.2) ml/min/1.73 m2. In patients with acute kidney injury (AKI), 30-day mortality increased with AKI stages (no AKI 41.7%, AKI stage 1 43.3%, AKI stage 2 50.0%, AKI stage 3 63.7%; adjusted hazard ratio [HR] for AKI stage 3 1.97, 95% confidence interval [CI] 1.56-2.48, p < 0.001). Similarly, severe renal dysfunction (eGFR ≤ median) was associated with a 21% higher 30-day mortality risk (61.0% vs. 40.1%; adjusted HR 1.48, 95% CI 1.20-1.84, p < 0.001). Sepsis and bleeding were associated with both AKI and renal dysfunction, even after adjustment.

CONCLUSIONS: In HF-CS, kidney injury is associated with higher 30-day mortality, potentially mediated by bleeding and sepsis. These findings support the consideration of kidney function as a prognostic marker and call for the development and evaluation of kidney-restoring adjunct interventions in HF-CS.

Originalsprache	Englisch
Zeitschrift	European Journal of Heart Failure
ISSN	1388-9842
DOIs	https://doi.org/10.1002/ejhf.3701
Publikationsstatus	Veröffentlicht - 2025

Fördermittel

: J.S. received travel fees from Abiomed, outside the submitted work. L.F.B. received speaker fees from Abiomed, outside the submitted work. S.B. reports fundings from Abbott Diagnostics, Amarin, AMGEN, AstraZeneca, Bayer, Siemens, and Novartis as well as honoraria for lectures and/or chairs from Abbott, Abbott Diagnostics, Bayer, Bristol Meyers Squibb, Boehringer Ingelheim, Daiichi Sankyo, GSK, LumiraDx, Novartis, Roche Diagnostics, and Thermo Fisher; he is a member of advisory boards and consultant of Thermo Fisher, and he is scientific advisor of Cardio\u2010CARE, a 100% non\u2010profit daughter of the K\u00FChne Foundation. J.D. received speaker fees from AstraZeneca, Bayer, Boehringer Ingelheim, Novartis and travel grants from AstraZeneca, Bayer, Daiichi Sankyo. P.K. received research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Center for Cardiovascular Research, from several drug and device companies active in atrial fibrillation and has received honoraria from several such companies in the past, but not in the last 5\u2009years; he is listed as inventor on two issued patents held by University of Hamburg (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). S.K. received research support from Cytosorbents and Daiichi Sankyo; lecture fees from ADVITOS, Biotest, CSL Behring, Daiichi Sankyo, Fresenius Medical Care, Gilead, Mitsubishi Tanabe Pharma, MSD, Pfizer, Shionogi and Zoll; and consultant fees from ADVITOS, Fresenius, Gilead, MSD and Pfizer. N.Ma. received personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, Bayer, Abbott, Abiomed, and Boston Scientific, outside the submitted work. S.M.W. reports Abiomed unrestricted grant for JenaMacs trial; speaker honoraria from Abiomed, Boston Scientific, Pfizer, Daichi Sankyo, outside the submitted work. M.O. reports speaker honoraria and travel compensations from companies Abbott Medical, AstraZeneca, Abiomed, Bayer vital, Biotronik, Bristol Myers Squibb, CytoSorbents, Daiichi Sankyo Deutschland, Edwards Lifesciences Services, Sedana Medical. A.P. reports institutional fees from Getinge and Abiomed, outside the submitted work, and research funding from the Medical Research Council and Barts Charity. T.R. has received honoraria, lecture fees, and grant support from Edwards Lifesciences, AstraZeneca, Bayer, Novartis, Berlin Chemie, Daiichi Sankyo, Boehringer Ingelheim, Novo Nordisk, Cardiac Dimensions, and Pfizer, outside the submitted work; he is co\u2010founder of Bimyo GmbH, a company that develops cardioprotective peptides, co\u2010founder of Sygnal GmbH, a company focusing on AI\u2010based ECG\u2010algorithms, and co\u2010founder of Yes2NO, developing nitric oxide\u2010based treatments. H.R. reports speaker honoraria from Edwards, Abiomed and Medtronic. C.S. reports speaker honoraria from AstraZeneca, outside the submitted work. P.C.S. reports grants from Boehringer Ingelheim, Abiomed Inc, Edwards Inc, Cytosorb Inc, Boston Scientific, and consulting fees and/or honoraria from Bayer, AstraZeneca, Daiichi Sankyo, Novartis, Actelion, Roche, Sanofi Aventis, Pharmacosmos, Medtronic, Thoratec, Boehringer Ingelheim, Heartware, Coronus, Abbott,Boston Scientific, St. Jude Medical, Abiomed and DGK, and trial committee work for Abbott, Abiomed. R.H.G.S reports speaker fees from AstraZeneca, Daiichi Sankyo, Edwards, Bristol Myers Squibb, Pfizer, Bayer Vital, Boehringer Ingelheim. C.Sk. received speaker fees from Abiomed, Boston Scientific and Bristol Myers Squibb. E.B.W. reports grants from Boehringer Ingelheim, and personal fees from Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, CVRx, Daiichi Sankyo, Pfizer, and Novartis, outside the submitted work. D.W. reports speaker fees from Abiomed, AstraZeneca, Bayer, Berlin\u2010Chemie, Boehringer Ingelheim, Novartis and Medtronic, outside the submitted work. B.S. reports speaker fees from Abiomed, Abbott, AstraZeneca and Inari; and research funding from the DFG, the EKFS, the DZHK and Abiomed, outside the submitted work. All other authors have nothing to disclose. Conflict of interest J.S. is supported by the German Research Foundation (grant number 546376900). P.K. was partially supported by European Union AFFECT\u2010AF (grant agreement 847770), and MAESTRIA (grant agreement 965286), British Heart Foundation (PG/20/22/35093; AA/18/2/34218), German Center for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK, grant numbers DZHK FKZ 81X2800182, 81Z0710116, and 81Z0710110), German Research Foundation (Ki 509167694), and Leducq Foundation.

Träger	Trägernummer
AstraZeneca
Novartis
CSL Behring
Cytosorbents
Edwards Lifesciences
Gilead
ADVITOS
Bundesministerium für Bildung und Forschung
Shionogi and Zoll
Bristol-Myers Squibb
Daiichi Sankyo
Medical Research Council
Boehringer Ingelheim
Fondation Leducq
CVRx
Amgen
MSD
Pfizer
trial committee work for Abbott
Bayer
EKFS
British Heart Foundation	PG/20/22/35093, AA/18/2/34218
MAESTRIA	965286
European Union AFFECT‐AF	847770
Deutsche Forschungsgemeinschaft	546376900
Deutsches Zentrum für Herz-Kreislaufforschung	Ki 509167694, DZHK FKZ 81X2800182, 81Z0710110, 81Z0710116

UN SDGs

Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung

SDG 3 – Gesundheit und Wohlergehen

Strategische Forschungsbereiche und Zentren

Zentren: Universitäres Herzzentrum Lübeck (UHZL)

DFG-Fachsystematik

2.22-12 Kardiologie, Angiologie

Dokumente

10.1002/ejhf.3701

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Sundermeyer, J., Kellner, C., Beer, B. N., Besch, L., Dettling, A., Bertoldi, L. F., Blankenberg, S., Dauw, J., Eckner, D., Eitel, I., Graf, T., Horn, P., Jozwiak-Nozdrzykowska, J., Kirchhof, P., Kluge, S., Linke, A., Landmesser, U., Lüsebrink, E., Majunke, N., ... Schrage, B. (2025). Kidney injury in patients with heart failure-related cardiogenic shock: Results from an international, multicentre cohort study. European Journal of Heart Failure. https://doi.org/10.1002/ejhf.3701

@article{82f8d894799e45dbbc8149a05b8e4f47,

title = "Kidney injury in patients with heart failure-related cardiogenic shock: Results from an international, multicentre cohort study",

abstract = "AIMS: Heart failure-related cardiogenic shock (HF-CS) accounts for about half of CS cases, with a paucity of data regarding the role of kidney injury in this subset. This study aims to evaluate patient characteristics and outcome associated with renal function in patients with HF-CS.METHODS AND RESULTS: In this multicentre, international, retrospective study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation, complications, and 30-day mortality, based on renal function, adjusted logistic and Cox regression models were fitted. Among 1010 HF-CS patients, the median age was 64 (interquartile range [IQR] 52-75) years, with 71.7\% being male. Median baseline creatinine was 1.7 (IQR 1.2-2.5) mg/dl, corresponding to an estimated glomerular filtration rate (eGFR) of 41.0 (IQR 25.2-62.2) ml/min/1.73 m2. In patients with acute kidney injury (AKI), 30-day mortality increased with AKI stages (no AKI 41.7\%, AKI stage 1 43.3\%, AKI stage 2 50.0\%, AKI stage 3 63.7\%; adjusted hazard ratio [HR] for AKI stage 3 1.97, 95\% confidence interval [CI] 1.56-2.48, p < 0.001). Similarly, severe renal dysfunction (eGFR ≤ median) was associated with a 21\% higher 30-day mortality risk (61.0\% vs. 40.1\%; adjusted HR 1.48, 95\% CI 1.20-1.84, p < 0.001). Sepsis and bleeding were associated with both AKI and renal dysfunction, even after adjustment.CONCLUSIONS: In HF-CS, kidney injury is associated with higher 30-day mortality, potentially mediated by bleeding and sepsis. These findings support the consideration of kidney function as a prognostic marker and call for the development and evaluation of kidney-restoring adjunct interventions in HF-CS.",

author = "Jonas Sundermeyer and Caroline Kellner and Beer, \{Benedikt N\} and Lisa Besch and Angela Dettling and Bertoldi, \{Letizia Fausta\} and Stefan Blankenberg and Jeroen Dauw and Dennis Eckner and Ingo Eitel and Tobias Graf and Patrick Horn and Joanna Jozwiak-Nozdrzykowska and Paulus Kirchhof and Stefan Kluge and Axel Linke and Ulf Landmesser and Enzo L{\"u}sebrink and Nicolas Majunke and Norman Mangner and Winkler, \{Sven M{\"o}bius\} and Peter Nordbeck and Martin Orban and Federico Pappalardo and Matthias Pauschinger and Michal Pazdernik and Alastair Proudfoot and Matthew Kelham and Tienush Rassaf and Hermann Reichenspurner and Clemens Scherer and Schulze, \{P Christian\} and Schwinger, \{Robert H G\} and Carsten Skurk and Marek Sramko and Guido Tavazzi and Holger Thiele and Luca Villanova and Nuccia Morici and Winzer, \{Ephraim B\} and Dirk Westermann and Benedikt Schrage",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). European Journal of Heart Failure published by John Wiley \& Sons Ltd on behalf of European Society of Cardiology.",

year = "2025",

doi = "10.1002/ejhf.3701",

language = "English",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "Oxford University Press",

}

Sundermeyer, J, Kellner, C, Beer, BN, Besch, L, Dettling, A, Bertoldi, LF, Blankenberg, S, Dauw, J, Eckner, D, Eitel, I , Graf, T, Horn, P, Jozwiak-Nozdrzykowska, J, Kirchhof, P, Kluge, S, Linke, A, Landmesser, U, Lüsebrink, E, Majunke, N, Mangner, N, Winkler, SM, Nordbeck, P, Orban, M, Pappalardo, F, Pauschinger, M, Pazdernik, M, Proudfoot, A, Kelham, M, Rassaf, T, Reichenspurner, H, Scherer, C, Schulze, PC, Schwinger, RHG, Skurk, C, Sramko, M, Tavazzi, G, Thiele, H, Villanova, L, Morici, N, Winzer, EB, Westermann, D & Schrage, B 2025, 'Kidney injury in patients with heart failure-related cardiogenic shock: Results from an international, multicentre cohort study', European Journal of Heart Failure. https://doi.org/10.1002/ejhf.3701

TY - JOUR

T1 - Kidney injury in patients with heart failure-related cardiogenic shock

T2 - Results from an international, multicentre cohort study

AU - Sundermeyer, Jonas

AU - Kellner, Caroline

AU - Beer, Benedikt N

AU - Besch, Lisa

AU - Dettling, Angela

AU - Bertoldi, Letizia Fausta

AU - Blankenberg, Stefan

AU - Dauw, Jeroen

AU - Eckner, Dennis

AU - Eitel, Ingo

AU - Graf, Tobias

AU - Horn, Patrick

AU - Jozwiak-Nozdrzykowska, Joanna

AU - Kirchhof, Paulus

AU - Kluge, Stefan

AU - Linke, Axel

AU - Landmesser, Ulf

AU - Lüsebrink, Enzo

AU - Majunke, Nicolas

AU - Mangner, Norman

AU - Winkler, Sven Möbius

AU - Nordbeck, Peter

AU - Orban, Martin

AU - Pappalardo, Federico

AU - Pauschinger, Matthias

AU - Pazdernik, Michal

AU - Proudfoot, Alastair

AU - Kelham, Matthew

AU - Rassaf, Tienush

AU - Reichenspurner, Hermann

AU - Scherer, Clemens

AU - Schulze, P Christian

AU - Schwinger, Robert H G

AU - Skurk, Carsten

AU - Sramko, Marek

AU - Tavazzi, Guido

AU - Thiele, Holger

AU - Villanova, Luca

AU - Morici, Nuccia

AU - Winzer, Ephraim B

AU - Westermann, Dirk

AU - Schrage, Benedikt

PY - 2025

Y1 - 2025

N2 - AIMS: Heart failure-related cardiogenic shock (HF-CS) accounts for about half of CS cases, with a paucity of data regarding the role of kidney injury in this subset. This study aims to evaluate patient characteristics and outcome associated with renal function in patients with HF-CS.METHODS AND RESULTS: In this multicentre, international, retrospective study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation, complications, and 30-day mortality, based on renal function, adjusted logistic and Cox regression models were fitted. Among 1010 HF-CS patients, the median age was 64 (interquartile range [IQR] 52-75) years, with 71.7% being male. Median baseline creatinine was 1.7 (IQR 1.2-2.5) mg/dl, corresponding to an estimated glomerular filtration rate (eGFR) of 41.0 (IQR 25.2-62.2) ml/min/1.73 m2. In patients with acute kidney injury (AKI), 30-day mortality increased with AKI stages (no AKI 41.7%, AKI stage 1 43.3%, AKI stage 2 50.0%, AKI stage 3 63.7%; adjusted hazard ratio [HR] for AKI stage 3 1.97, 95% confidence interval [CI] 1.56-2.48, p < 0.001). Similarly, severe renal dysfunction (eGFR ≤ median) was associated with a 21% higher 30-day mortality risk (61.0% vs. 40.1%; adjusted HR 1.48, 95% CI 1.20-1.84, p < 0.001). Sepsis and bleeding were associated with both AKI and renal dysfunction, even after adjustment.CONCLUSIONS: In HF-CS, kidney injury is associated with higher 30-day mortality, potentially mediated by bleeding and sepsis. These findings support the consideration of kidney function as a prognostic marker and call for the development and evaluation of kidney-restoring adjunct interventions in HF-CS.

AB - AIMS: Heart failure-related cardiogenic shock (HF-CS) accounts for about half of CS cases, with a paucity of data regarding the role of kidney injury in this subset. This study aims to evaluate patient characteristics and outcome associated with renal function in patients with HF-CS.METHODS AND RESULTS: In this multicentre, international, retrospective study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation, complications, and 30-day mortality, based on renal function, adjusted logistic and Cox regression models were fitted. Among 1010 HF-CS patients, the median age was 64 (interquartile range [IQR] 52-75) years, with 71.7% being male. Median baseline creatinine was 1.7 (IQR 1.2-2.5) mg/dl, corresponding to an estimated glomerular filtration rate (eGFR) of 41.0 (IQR 25.2-62.2) ml/min/1.73 m2. In patients with acute kidney injury (AKI), 30-day mortality increased with AKI stages (no AKI 41.7%, AKI stage 1 43.3%, AKI stage 2 50.0%, AKI stage 3 63.7%; adjusted hazard ratio [HR] for AKI stage 3 1.97, 95% confidence interval [CI] 1.56-2.48, p < 0.001). Similarly, severe renal dysfunction (eGFR ≤ median) was associated with a 21% higher 30-day mortality risk (61.0% vs. 40.1%; adjusted HR 1.48, 95% CI 1.20-1.84, p < 0.001). Sepsis and bleeding were associated with both AKI and renal dysfunction, even after adjustment.CONCLUSIONS: In HF-CS, kidney injury is associated with higher 30-day mortality, potentially mediated by bleeding and sepsis. These findings support the consideration of kidney function as a prognostic marker and call for the development and evaluation of kidney-restoring adjunct interventions in HF-CS.

UR - https://www.scopus.com/pages/publications/105007024100

UR - https://www.mendeley.com/catalogue/a7141c40-f0cb-3a0a-81e7-f73846a7fd5f/

U2 - 10.1002/ejhf.3701

DO - 10.1002/ejhf.3701

M3 - Journal articles

C2 - 40436616

SN - 1388-9842

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

ER -

Kidney injury in patients with heart failure-related cardiogenic shock: Results from an international, multicentre cohort study

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