# Low levels of adropin are associated with acute kidney injury after decongestion in patients with acutely decompensated heart failure

## TL;DR

Low levels of adropin in heart failure patients predict acute kidney injury after treatment to reduce fluid overload.

## Contribution

Adropin levels are shown to be a novel and more accurate predictor of acute kidney injury compared to traditional markers in heart failure patients.

## Key findings

- Low adropin levels (<2.1 ng/mL) independently predict acute kidney injury in acutely decompensated heart failure patients.
- Adropin's predictive power is higher than urinary albumin/creatinine ratio and NT-proBNP for acute kidney injury.
- Combining adropin levels with NT-proBNP improves discrimination for predicting acute kidney injury.

## Abstract

Patients with acutely decompensated heart failure (ADHF) demonstrated a high risk of acute kidney injury (AKI) and its transition to acute kidney disease after diuretic therapy to reach euvolemic status. The purpose of the study was to investigate whether circulating levels of adropin predict AKI in ADHF patients after decongestive therapy.

A total of 325 individuals fulfilling the inclusion criteria of ADHF were consecutively enrolled from October 2020 to October 2024. The study was designed as prospective cohort study. The congestion was assessed using Framingham criteria of congestion (Framingham heart failure score ≥ 2). Patients with AHDF were divided into 2 groups according to the presence of AKI (n = 113) and without AKI (n = 212). Circulating levels of N-terminal brain natriuretic pro-peptide (NT-proBNP), high-sensitivity C-reactive protein, high-sensitive troponin T, interleukin-6, tumor necrosis factor-alpha, soluble suppression of tumorigenicity-2, procalcitonin were measured. Predictors of AKI were identified using univariate and multivariate logistic regression analysis.

We found that the presence of atrial fibrillation, urinary albumin/creatinine ratio (UACR) ≥16.5 mg/g Cr, serum levels of adropin<2.1 ng/mL and NT-proBNP ≥19,540 pmol/mL were independent predictors for AKI in patients with ADHF. UACR and atrial fibrillation revealed a strict similarity in prediction of AKI, whereas discriminative ability of adropin<2.1 ng/mL were higher to NT-proBNP ≥19,540 pmol/mL. The combined predictive model (low levels of adropin + higher levels of NT-proBNP) showed significantly better discriminatory power compared to other models.

Low levels of adropin<2.1 ng/mL on hospital admission in patients with ADHF can predict AKI and that its predictive ability was significantly higher compared with the conventionally used urinary albumin/creatinine ratio and NT-proBNP. Adropin may add predictive information to NT-proBNP for AKI in individuals with ADHF.

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•Serum adropin<2.1 ng/mL were associated with acute kidney injury in patients with acutely decompensated heart failure•Predictive ability of low levels of adropin is higher to urinary albumin/creatinine ratio•Low serum levels of adropin improve the discriminatory power of NT-proBNP for acute kidney injury•Measurement of adropin can prevent acute kidney injury after decongestion during hospital stay

Serum adropin<2.1 ng/mL were associated with acute kidney injury in patients with acutely decompensated heart failure

Predictive ability of low levels of adropin is higher to urinary albumin/creatinine ratio

Low serum levels of adropin improve the discriminatory power of NT-proBNP for acute kidney injury

Measurement of adropin can prevent acute kidney injury after decongestion during hospital stay