Acute kidney injury (AKI) in patients hospitalized with acute heart failure (AHF) often reflect the combined effects of venous congestion, renal hypoperfusion, and neurohormonal activation. A prospective monocentric study presented at the Heart Failure 2026 evaluated whether admission hypochloremia and systemic venous congestion assessed using the Venous Excess Ultrasound (VExUS) score could help identify patients at increased risk for AKI.

The study included consecutive adults admitted to the intensive care unit with acute de novo or acutely decompensated chronic heart failure between February and December 2024. Renal outcomes were assessed during hospitalization and up to six months after discharge, with AKI defined using standard diagnostic criteria.
Findings

• A total of 87 patients were included, and 67 (77%) developed AKI during follow-up.
• Among patients who developed AKI, 62.7% had severe venous congestion defined as VExUS grade 3.
• Hypochloremia (serum chloride <96 mmol/L) was present in 43.3% of patients with AKI.
• In multivariable analysis, VExUS grade 3 was independently associated with AKI: OR 2.84 (95% CI 1.01–9.21; p=0.047).
• Hypochloremia was also independently associated with AKI: OR 4.32 (95% CI 1.15–16.20; p=0.030).
• The VExUS score demonstrated good discriminatory performance for AKI prediction with an AUC of 0.76.
• Combining VExUS grade 3 with hypochloremia improved discrimination for AKI risk (AUC 0.82).

The combined use of VExUS assessment and serum chloride measurement improved risk discrimination compared with congestion assessment alone.