***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Increased central venous pressures have been associated with the development of worsening renal function ( WRF ) , an important marker of prognosis . We sought to determine the incidence and prognostic significance of WRF in pulmonary hypertension patients ( PH ) with isolated right HF . A prospect i ve study of PH clinic patients admitted to hospital for right HF . WRF was defined as a rise in creatinine of 26 μmol/L ( 0.3 mg/dL ) within the first 48 hours of admission . A total of 32 patients were enrolled in this study , 67 % of patients had moderate-severe chronic kidney disease with an eGFR ≤ 60 mL/min and 34 % ( n=11 ) developed WRF  during their admission . The mean right atrial pressure was higher in patients with WRF ( 19 ± 7 mm Hg vs 12 ± 6 mm Hg , P=.05 ) . A total of 36 % of patients with WRF died in hospital compared to 5 % in the group that did not develop WRF ( OR for hospital death 13.3 ± 16 , P=.03 ) . The combined endpoint of death or readmission at 6 months was 45 % in the WRF group and 43 % in the group without WRF ( P=.89 ) . Significant renal dysfunction is common in patients with PH and an acute decline in renal function is an important marker of in hospital death and short term mortality in right heart failure Aims : To determine if newer criteria for diagnosing and staging acute kidney injury ( AKI ) during heart failure ( HF ) admission are more predictive of clinical outcomes at 30 days and 1 year than the traditional worsening renal function ( WRF ) definition . Methods : We analyzed prospect ively collected clinical data on 637 HF admissions with 30-day and 1-year follow-up . The incidence , stages , and outcomes of AKI were determined using the following four definitions : KDIGO , RIFLE , AKIN , and WRF ( serum creatinine rise ≥0.3 mg/dl ) . Receiver operating curves were used to compare the predictive ability of each AKI definition for the occurrence of adverse outcomes ( death , rehospitalization , dialysis ) . Results : AKI by any definition occurred in 38.3 % ( 244/637 ) of cases and was associated with an increased incidence of 30-day ( 32.3 vs. 6.9 % , χ2 = 70.1 ; p < 0.001 ) and 1-year adverse outcomes ( 67.5 vs. 31.0 % , χ2 = 81.4 ; p < 0.001 ) . Most importantly , there was a stepwise increase in primary outcome with increasing stages of AKI severity using RIFLE , KDIGO , or AKIN ( p < 0.001 ) . In direct comparison , there were only small differences in predictive abilities between RIFLE and KDIGO and WRF concerning clinical outcomes at 30 days ( AUC 0.76 and 0.74 vs. 0.72 , χ2 = 5.6 ; p = 0.02 ) as well as for KDIGO and WRF at 1 year ( AUC 0.67 vs. 0.65 , χ2 = 4.8 ; p = 0.03 ) . Conclusion : During admission for HF , the benefits of using newer AKI classification systems ( RIFLE , AKIN , KDIGO ) lie with the ability to identify those patients with more severe degrees of AKI who will go on to experience adverse events at 30 days and 1 year . The differences in terms of predictive abilities were only marginal Background Acute kidney injury ( AKI ) increases the risk of death after acute myocardial infa rct ion ( AMI ) . Recently , a new AKI definition was proposed by the Kidney Disease Improving Global Outcomes ( KDIGO ) organization . The aim of the current study was to compare the incidence and the early and late mortality of AKI diagnosed by RIFLE and KDIGO criteria in the first 7 days of hospitalization due to an AMI . Methods and Results In total , 1,050 AMI patients were prospect ively studied . AKI defined by RIFLE and KDIGO occurred in 14.8 % and 36.6 % of patients , respectively . By applying multivariate Cox analysis , AKI was associated with an increased adjusted hazard ratio ( AHR ) for 30-day death of 3.51 ( 95 % confidence interval [ CI ] 2.35–5.25 , p<0.001 ) by RIFLE and 3.99 ( CI 2.59–6.15 , p<0.001 ) by KDIGO and with an AHR for 1-year mortality of 1.84 ( CI 1.12–3.01 , p = 0.016 ) by RIFLE and 2.43 ( CI 1.62–3.62 , p<0.001 ) by KDIGO . The subgroup of patients diagnosed as non-AKI by RIFLE but as AKI by KDIGO criteria had also an increased AHR for death of 2.55 ( 1.52–4.28 ) at 30 days and 2.28 ( CI 1.46–3.54 ) at 1 year ( p<0.001 ) . Conclusions KDIGO criteria detected substantially more AKI patients than RIFLE among AMI patients . Patients diagnosed as AKI by KDIGO but not RIFLE criteria had a significantly higher early and late mortality . In this study KDIGO criteria were more suitable for AKI diagnosis in AMI patients than RIFLE criteria Baseline renal function is a potent independent risk factor for adverse events after acute myocardial infa rct ion ( MI ) . Worsening renal function ( WRF ) has been shown to influence outcomes in the heart failure population , but its impact on cardiovascular risk in the post-MI period has not been well defined . For assessment of the prognostic importance of WRF , 2231 patients who had left ventricular dysfunction and were enrolled in the Survival and Ventricular Enlargement ( SAVE ) trial were studied . Patients were r and omly assigned between 3 and 16 d ( average 11 d ) after acute MI to receive captopril or placebo ; those with a serum creatinine of > 2.5 mg/dl were excluded from SAVE . WRF was defined as an increase in creatinine of > 0.3 mg/dl measured from baseline to 2 wk after r and omization . The predictive value of WRF on cardiovascular morbidity and mortality was examined during 42 mo of follow-up . Paired serum creatinine measurements at baseline and 2 wk were available in 1854 patients .  WRF occurred in 223 ( 12.0 % ) patients and was a stronger predictor of death ( hazard ratio [ HR ] 1.46 ; 95 % confidence interval [ CI ] 1.05 to 2.02 ) than baseline creatinine ( HR 1.31 ; 95 % CI 1.01 to 1.70 ) . WRF also showed an increased risk for cardiovascular death ( HR 1.62 ; 95 % CI 1.14 to 2.30 ) and the composite end point ( HR 1.32 ; 95 % CI 1.03 to 1.70 ) . When stratified by treatment , 104 ( 5.7 % ) and 116 ( 6.4 % ) patients with WRF in the placebo and captopril groups had no significant association between treatment group and WRF ( P = 0.38 ) . The risk for death associated with WRF was HR 1.63 ( 95 % CI 1.05 to 2.52 ) in the placebo group compared with HR 1.33 ( 95 % CI 0.81 to 2.21 ) in the captopril group ( P = 0.49 for interaction ) . WRF as early as 2 wk after MI was not uncommon ( 12.0 % ) and was associated with increased mortality in patients without renal dysfunction at baseline . Patients who received captopril did not demonstrate more WRF than patients who received placebo . Monitoring serum creatinine in patients during the first few weeks after MI may help to identify those who are at highest risk and guide effective long-term therapeutic choices Background The role of an impaired estimated glomerular filtration rate ( eGFR ) at hospital admission in the outcome of acute kidney injury ( AKI ) after acute myocardial infa rct ion ( AMI ) has been underreported . The aim of this study was to assess the influence of an admission eGFR<60 mL/min/1.73 m2 on the incidence and early and late mortality of AMI-associated AKI . Methods A prospect i ve study of 828 AMI patients was performed . AKI was defined as a serum creatinine increase of ≥50 % from the time of admission ( RIFLE criteria ) in the first 7 days of hospitalization . Patients were divided into subgroups according to their eGFR upon hospital admission ( MDRD formula , mL/min/1.73 m2 ) and the development of AKI : eGFR≥60 without AKI , eGFR<60 without AKI , eGFR≥60 with AKI and eGFR<60 with AKI . Results Overall , 14.6 % of the patients in this study developed AKI . The admission eGFR had no impact on the incidence of AKI . However , the admission eGFR was associated with the outcome of AMI-associated AKI . The adjusted hazard ratios ( AHR , Cox multivariate analysis ) for 30-day mortality were 2.00 ( 95 % CI 1.11–3.61 ) for eGFR<60 without AKI , 4.76 ( 95 % CI 2.45–9.26 ) for eGFR≥60 with AKI and 6.27 ( 95 % CI 3.20–12.29 ) for eGFR<60 with AKI . Only an admission eGFR of < 60 with AKI was significantly associated with a 30-day to 1-year mortality hazard ( AHR 3.05 , 95 % CI 1.50–6.19 ) . Conclusions AKI development was associated with an increased early mortality hazard in AMI patients with either preserved or impaired admission eGFR . Only the association of impaired admission eGFR and AKI was associated with an increased hazard for late mortality among these patients Introduction The development of acute kidney injury ( AKI ) is associated with poor outcome . The modified RIFLE ( risk , injury , failure , loss of kidney function , and end-stage renal failure ) classification for AKI , which classifies patients with renal replacement therapy needs according to RIFLE failure class , improves the predictive value of AKI in patients undergoing cardiac surgery . Our aim was to assess risk factors for post-operative AKI and the impact of renal function on short- and long-term survival among all AKI subgroups using the modified RIFLE classification . Methods We prospect ively studied 2,940 consecutive cardiosurgical patients between January 2004 and July 2009 .  AKI was defined according to the modified RIFLE system . Pre-operative , operative and post-operative variables usually measured on and during admission , which included main outcomes , were recorded together with cardiac surgery scores and ICU scores . These data were evaluated for association with AKI and staging in the different RIFLE groups by means of multivariable analyses . Survival was analyzed via Kaplan-Meier and a risk-adjusted Cox proportional hazards regression model . A complete follow-up ( mean 6.9 ± 4.3 years ) was performed in 2,840 patients up to April 2013 . Results Of those patients studied , 14 % ( n = 409 ) were diagnosed with AKI . We identified one intra-operative ( higher cardiopulmonary bypass time ) and two post-operative ( a longer need for vasoactive drugs and higher arterial lactate 24 hours after admission ) predictors of AKI . The worst outcomes , including in-hospital mortality , were associated with the worst RIFLE class . Kaplan-Meier analysis showed survival of 74.9 % in the RIFLE risk group , 42.9 % in the RIFLE injury group and 22.3 % in the RIFLE failure group ( P < 0.001 ) . Classification at RIFLE injury ( Hazard ratio ( HR ) = 2.347 , 95 % confidence interval ( CI ) 1.122 to 4.907 , P = 0.023 ) and RIFLE failure ( HR = 3.093 , 95 % CI 1.460 to 6.550 , P = 0.003 ) were independent predictors for long-term patient mortality . Conclusions AKI development after cardiac surgery is associated mainly with post-operative variables , which ultimately could lead to a worst RIFLE class . Staging at the RIFLE injury and RIFLE failure class is associated with higher short- and long-term mortality in our population AIMS To determine the prevalence and risk factors for worsening renal function ( WRF ) among patients hospitalized for decompensated heart failure ( HF ) and the association with subsequent re-hospitalization and mortality . METHODS AND RESULTS We prospect ively enrolled 299 patients across eight European countries ( mean 
    Output:
    
Increasing AKI severity was associated with worse outcomes .
The impact of CRS-1 defined by AKI on mortality was greatest in CS patients .
AHF patients experienced the highest occurrence rate of AKI , but the impact on mortality was greatest in CS patients