Acute Kidney Injury Following Percutaneous Coronary Intervention for Acute Coronary Syndrome: Incidence, Aetiology, Risk Factors and Outcomes

Abstract

We investigated the predictors, aetiology and long-term outcomes of acute kidney injury (AKI) following urgent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Acute kidney injury occurred in 198 (7.2%) of 2917 patients: 14.1% of AKI cases were attributed to cardiogenic shock and 5.1% were classified as atheroembolic renal disease (AERD). Significant risk factors for AKI included age (odds ratio [OR] 1.05, 95% confidence limits [CI] 1.03-1.06), diabetes (OR 1.73, 95% CI 1.20-2.47), hypertension (OR 1.43, 95% CI 1.03-2.00), heart failure (OR 3.01, 95% CI 1.58-5.57), femoral access (OR 1.50, 95% CI 1.03-2.15), cardiogenic shock (OR 2.03, 95% CI 1.19-3.37) and ST-elevation myocardial infarction (STEMI) (OR 3.89, 95% CI 2.80-5.47). One-year mortality after AERD was 44.4% and renal replacement therapy (RRT) requirement 22.2% (compared with mortality 33.3% and RRT requirement 7.4%, respectively, in all other AKI patients). Mortality at 1 year was associated with AKI (OR 4.33, 95% CI 2.89-6.43), age (OR 1.08, 95% CI 1.06-1.09), heart failure (OR 1.92, 95% CI 1.05-3.44), femoral access (OR 2.05, 95% CI 1.41-2.95) and cardiogenic shock (OR 3.63, 95% CI 2.26-5.77). Acute kidney injury after urgent PCI is strongly associated with worse outcomes. Atheroembolic renal disease has a poor outcome and a high likelihood of long-term RRT requirement.

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

“…The significantly increased mortality rates among patients with AKI versus patients without in the setting of ACS and following PCI are consistent with previous reports [5][6][7][8][9][10][11]25,37,38]. However, the mortality rates among ACS patients who developed AKI in our study are somewhat higher than those reported in most previous studies (up to 44%).…”

Short-term outcomes after transplantation of deceased donor kidneys with acute kidney injury: a retrospective analysis of a multicenter cohort of marginal donor kidneys with post-explantation biopsies

“…Similar to others, we confirmed classical risk factors for AKI, such as diabetes mellitus, BMI and preexisting chronic kidney disease [ 21 – 23 ]. Moreover, the longer duration of ICU stay, and the less common use of steroids and volume expanders in the donor AKI group emphasize the importance of the systemic inflammatory response and intravascular volume depletion respectively as modifiable risk factors for AKI in the ICU setting [ 24 – 26 ].…”

Global Perspectives in Acute Kidney Injury: Japan

“…Their analysis showed that AKI occurred in 14% of the patients who were eligible. Given recent clinical studies from other developed nations have reported the AKI incidence in AMI patients ranged from 7% to 17%, the incidence of AKI in Japanese patients with ACS appears to be similar to that of other countries (3 –6).…”

“…Given that recent clinical studies from other developed nations have reported that the AKI incidence in AMI patients ranged from 7% to 17%, the incidence of AKI in Japanese ACS patients appears to be similar to that of other countries. [3][4][5][6] Meanwhile, Fujii conducted a multicenter prospective cohort trial (n=2,421) to explore the AKI epidemiology in a mixed Japanese ICU. 7 Their analysis showed that the cumulative incidence of AKI was 44.7% among Japanese ICU patients.…”