Chronic Kidney Disease Progression and Cardiovascular Outcomes Following Cardiac Catheterization—A Population‐Controlled Study

Abstract

BackgroundStudies of kidney disease associated with cardiac catheterization typically rely on billing records rather than laboratory data. We examined the associations between percutaneous coronary interventions, acute kidney injury, and chronic kidney disease progression using comprehensive Veterans Affairs clinical and laboratory databases.Methods and ResultsPatients undergoing percutaneous coronary interventions between 2005 and 2010 (N=24 405) were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking registry and examined for associated acute kidney injury and chronic kidney disease development or progression relative to 24 405 matched population controls. Secondary outcomes analyzed included dialysis, acute myocardial infarction, and mortality. The incidence of chronic kidney disease progression following percutaneous coronary interventions complicated by acute kidney injury, following uncomplicated coronary interventions, and in matched controls were 28.66, 11.15, and 6.81 per 100 person‐years, respectively. Percutaneous coronary intervention also increased the likelihood of chronic kidney disease progression in both the presence and absence of acute injury relative to controls in adjusted analyses (hazard ratio [HR], 5.02 [95% CI, 4.68–5.39]; and HR, 1.76 [95% CI, 1.70–1.86]). Among patients with estimated glomerular filtration rate <60 mL/min per 1.73 m2, acute kidney injury increased the likelihood of disease progression by 8‐fold. Similar results were observed for all secondary outcomes.ConclusionsAcute kidney injury following percutaneous coronary intervention was associated with increased chronic kidney disease development and progression and mortality.

Chronic kidney disease progression in patients with chronic hepatitis B on tenofovir, entecavir, or no treatment

“…The CKD progression was defined as an increase in CKD stage for at least one stage for at least three consecutive months during follow‐up. Albuminuria (by spot urine albumin‐creatinine ratio), reduction of eGFR by 20%, increase in creatinine by 25% from baseline, and eGFR falling below 50 mL/min/1.73 m 2 for at least three consecutive months were analysed . Transient deterioration in renal function with complete recovery within 3 months was not counted as an event; whereas in the CKD stage, eGFR and serum creatinine in the particular episode of deterioration with partial recovery of renal function was detected and analysed.…”

“…Albuminuria (by spot urine albumin-creatinine ratio), reduction of eGFR by 20%, increase in creatinine by 25% from baseline, and eGFR falling below 50 mL/min/1.73 m 2 for at least three consecutive months were analysed. 13,14 Transient deterioration in renal function with complete recovery within 3 months was not counted as an event; WONG ET AL.…”

“…The overall median (interquartile range) number of renal function tests was 7 (4-12); 5 (3)(4)(5)(6)(7)(8) in the untreated cohort; 9 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) in the ETV-treated cohort; and 8 (5)(6)(7)(8)(9)(10)(11)(12)(13) in the TDF-treated cohort. Detailed progression and regression in CKD stage from baseline to the last visit is described in Table 3).…”

Meta-Analysis of AKI-CKD Transition in Perioperative Patients

“…Seven studies described AKI to CKD transition in nonperioperative populations. These included patients undergoing coronary angiography/cardiac catheterization [14][15][16], non-myeloablative hematopoietic cell transplantation [17], myeloablative allogeneic hematopoietic cell transplantation [18], suffering from myocardial infarction or pneumonia [19], or with mixed medical etiologies [20].…”

Remote ischemic preconditioning for prevention of contrast induced nephropathy—Insights from an Indian study

“…The present study attempts to prove if 4 cycles of RIPC could offer a means of protection against CIN and post PCI renal worsening in high risk patients undergoing PCI. Though CIN traditionally occurs up to 48 to 72 h after PCI, studies have shown that minor derangements in eGFR which do not fall into the gamut of CIN continue to accrue in patients even after hospital discharge 10, 11. It was with this objective that we decided to study if RIPC positively influenced the renal parameters of the study patients at 24 h, 48 h, 2 weeks and 6 weeks.…”