The mechanisms underlying long-term sequelae after AKI remain unclear. Vessel instability, an early response to endothelial injury, may reflect a shared mechanism and early trigger for CKD and heart failure.

To investigate whether plasma angiopoietins, markers of vessel homeostasis, are associated with CKD progression and heart failure admissions after hospitalization in patients with and without AKI, we conducted a prospective cohort study to analyze the balance between angiopoietin-1 (Angpt-1), which maintains vessel stability, and angiopoietin-2 (Angpt-2), which increases vessel destabilization. Three months after discharge, we evaluated the associations between angiopoietins and development of the primary outcomes of CKD progression and heart failure and the secondary outcome of all-cause mortality 3 months after discharge or later.

Median age for the 1503 participants was 65.8 years; 746 (50%) had AKI. Compared with the lowest quartile, the highest quartile of the Angpt-1:Angpt-2 ratio was associated with 72% lower risk of CKD progression (adjusted hazard ratio [aHR], 0.28; 95% confidence interval [CI], 0.15 to 0.51), 94% lower risk of heart failure (aHR, 0.06; 95% CI, 0.02 to 0.15), and 82% lower risk of mortality (aHR, 0.18; 95% CI, 0.09 to 0.35) for those with AKI. Among those without AKI, the highest quartile of Angpt-1:Angpt-2 ratio was associated with 71% lower risk of heart failure (aHR, 0.29; 95% CI, 0.12 to 0.69) and 68% less mortality (aHR, 0.32; 95% CI, 0.15 to 0.68). There were no associations with CKD progression.

A higher Angpt-1:Angpt-2 ratio was strongly associated with less CKD progression, heart failure, and mortality in the setting of AKI.

AKI 后长期后遗症的潜在机制仍不清楚。血管不稳定是对内皮损伤的早期反应，可能反映了 CKD 和心力衰竭的共同机制和早期触发因素。

为了研究血浆血管生成素（血管稳态标志物）是否与患有和不患有 AKI 的患者住院后的 CKD 进展和心力衰竭入院相关，我们进行了一项前瞻性队列研究，以分析血管生成素-1 (Angpt-1) 与血管生成素-1 (Angpt-1) 之间的平衡。维持血管稳定性和血管生成素 2 (Angpt-2)，这会增加血管不稳定。出院后三个月，我们评估了血管生成素与 CKD 进展和心力衰竭主要结局的发展以及出院后 3 个月或更晚全因死亡率的次要结局之间的关联。

1503 名参与者的中位年龄为 65.8 岁；746 (50%) 人患有 AKI。与最低四分位数相比，Angpt-1:Angpt-2 比率的最高四分位数与 CKD 进展风险降低 72% 相关（调整后风险比 [aHR]，0.28；95% 置信区间 [CI]，0.15 至 0.51 )、AKI 患者的心力衰竭风险降低 94%（aHR，0.06；95% CI，0.02 至 0.15），死亡风险降低 82%（aHR，0.18；95% CI，0.09 至 0.35）。在没有 AKI 的人群中，Angpt-1:Angpt-2 比率的最高四分位数与心力衰竭风险降低 71%（aHR，0.29；95% CI，0.12 至 0.69）和死亡率降低 68%（aHR，0.32；95% CI，0.12 至 0.69）相关。 95% 置信区间，0.15 至 0.68）。与 CKD 进展无关。

较高的 Angpt-1:Angpt-2 比率与 AKI 情况下较少的 CKD 进展、心力衰竭和死亡率密切相关。