Assessing the Risk of Heart Failure in Patients With Acute Kidney Injury

When Sherry Mansour, MD, assistant professor of medicine (nephrology), first began her training at Yale, she was struck by the high rates of heart failure among her patients with kidney disease.

For many patients—especially those with advanced kidney disease approaching dialysis or already on dialysis—nephrologists often serve as both the kidney specialist and de facto primary care provider. However, nephrologists are not primarily trained or focused on managing nonrenal issues.

This gap in care sparked Mansour’s research. She set out to better understand the biological link between kidney injury and heart failure, aiming to identify patients at the highest risk and ensure they receive timely preventive measures, primary care follow-up, and specialist referrals.

“In the nephrology clinic, our focus is understandably on the kidney, but there is a need to integrate cardiovascular disease prevention,” Mansour says.

Most patients with kidney disease die not from kidney failure itself, but from heart failure, heart attacks, or sudden cardiac death.

Her recent study, published in BMC Nephrology, analyzed blood samples from nearly 1,500 hospitalized patients, half of whom had experienced acute kidney injury (AKI). Mansour and her team tested nine proteins known as vascular biomarkers, which reflect how well blood vessels are repairing or failing to repair after illness.

Using advanced clustering analysis, the researchers identified three patient profiles: a vascular injury group with poor repair, a repair group with strong recovery, and a dormant group with low signals of both injury and repair.

The researchers found that patients who had acute kidney injury while in the hospital, clustered in the vascular injury group, faced the highest risks of heart failure, kidney disease progression, and even death in the years after hospitalization.

“Those in the injury group were much more likely to have poor outcomes compared to the repair group,” Mansour says. “What fascinated me was that the computer had no knowledge of these patients or their outcomes yet was able to capture everything through biology alone.”

For Mansour, the clinical implications are clear: If clinicians can flag patients at highest risk for heart failure after AKI, they can devote more time to counseling on preventive strategies like diet, smoking cessation, and cardiovascular monitoring.

Mansour stresses that while the biomarker findings are promising, they are not yet ready for routine clinical use and must be validated in other patient groups. In the meantime, she is applying this work to kidney transplant patients, who remain at sharply elevated risk of heart disease even after receiving a new kidney.

For her, the ultimate goal is prevention of heart disease in patients with kidney disease.

“Most patients with kidney disease die not from kidney failure itself, but from heart failure, heart attacks, or sudden cardiac death,” she explains. That reality calls for a shift in focus. “We can’t wait for the disease to happen and then react—we need to be proactive, and intervene early, protecting both the kidney and the heart before problems arise.”

The research reported in this news article was supported by the National Institutes of Health (award 1K23DK127154-01A1), the American Heart Association (award 18CDA34110151), and Yale University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or American Heart Association.

Nephrology is one of 10 sections in the Yale Department of Internal Medicine. Committed to excellence in patient care, research, and education, the section’s faculty and trainees aim to be national and international leaders in academic nephrology. To learn more, visit Nephrology.