Acute Kidney Injury Following Admission with Acute Coronary Syndrome: The Role of Diabetes Mellitus

Abstract

Purpose: To evaluate the role of diabetes mellitus in the incidence, risk factors, and outcomes of AKI (acute kidney injury) in patients admitted with ACS (acute coronary syndrome). Methods: We performed a comparative evaluation of ACS patients with vs. without DM who developed AKI enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2018. AKI was defined as an absolute increase in serum creatinine (³0.5 mg/dL) or above 1.5 mg/dL or new renal replacement therapy upon admission with ACS. Outcomes included 30-day major adverse cardiovascular events (MACE) and 1-year all-cause mortality. Results: The current study included a total of 16,879 patients, median age 64 (IQR 54–74), 77% males, 36% with DM. The incidence of AKI was significantly higher among patients with vs. without DM (8.4% vs. 4.7%, p < 0.001). The rates of 30-day MACE (40.8% vs. 13.4%, p < 0.001) and 1-year mortality (43.7% vs. 10%, p < 0.001) were significantly greater among diabetic patients who developed vs. those who did not develop AKI respectively, yet very similar among patients that developed AKI with vs. without DM (30-day MACE 40.8% vs. 40.3%, p = 0.9 1-year mortality 43.7 vs. 44.8%, p = 0.8, respectively). Multivariate analyses adjusted to potential confounders, showed similar independent predictors of AKI among patients with and without DM, comprising; older age, chronic kidney disease, congestive heart failure, and peripheral arterial disease. Conclusions: Although patients with DM are at much greater risk for AKI when admitted with ACS, the independent predictors of AKI and the worse patient outcomes when AKI occurs, are similar irrespective to DM status.

Frequency and Predictors of Acute Kidney Injury in Patients With Acute Coronary Syndrome in a Tertiary Care Hospital: A Retrospective Study

“…Similar findings were obtained by the study conducted by Sinkovič et al [17]. A study conducted by Shiyovich et al found that patients with diabetes mellitus have a higher risk of developing AKI when admitted with ACS [21]. Diabetes mellitus is associated with increased oxidative stress and reactive oxygen species (ROS) arbitrated by enhanced activity of reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and increased mitochondrial superoxide [22].…”

Acute kidney injury in diabetes mellitus: Epidemiology, diagnostic, and therapeutic concepts

“…41 An independent study of 16 879 patients (median age 64, 77% males, 36% with DM) showed higher AKI incidence among patients with DM versus without DM (8.4% vs. 4.7%) following admission with the acute coronary syndrome and those DM-AKI patients had greater rates of 30-day MACE and 1-year mortality when compared to DM-non-AKI patients. 42 These data support that DM patients developing AKI in any revascularization method amid cardiac surgery often indicate a worse prognosis. [56][57][58] Furthermore, independent of preoperative kidney function, the incidence of AKI was much higher in 1-DM patients than in 2-DM after CABG, but the differences in long-term prognosis remain unclear.…”

“…In these patients, AKI was associated with a higher risk for major cardiovascular events (MACE) and death at 5 years irrespective of whether CABG or PCI was performed 41 . An independent study of 16 879 patients (median age 64, 77% males, 36% with DM) showed higher AKI incidence among patients with DM versus without DM (8.4% vs. 4.7%) following admission with the acute coronary syndrome and those DM‐AKI patients had greater rates of 30‐day MACE and 1‐year mortality when compared to DM‐non‐AKI patients 42 . These data support that DM patients developing AKI in any revascularization method amid cardiac surgery often indicate a worse prognosis 56–58 .…”

Chronic Renal Failure and Cardiovascular Disease: A Comprehensive Appraisal

“…All other diabetic patients are classified at either high risk (5–10%) or very high risk (>10%) [ 31 ]. CKD in patients with DM is associated with higher rates of cardiovascular disease and should be considered in the highest risk group for prognostication and/or therapeutic management [ 55 , 56 , 57 ]. Special attention should be given to diabetic patients with abnormal proteinuria, as its presence further increases cardiovascular events and mortality [ 58 ].…”