Impaired renal function is associated with adverse outcomes in patients with chest pain discharged from internal medicine wards

Topaz, Guy; Gharra, Wesal; Eisen, Alon; Hershko, Alon Y.; Shilo, Lotan; Beeri, Gil; Kitay-Cohen, Yona; Pereg, David

doi:10.1016/j.ejim.2018.01.034

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…Appropriate preparation to the TAVI procedure, also considering the risk of AKI, and minimization of this risk, especially in patients with CKD [29][30][31] appear to be important goals to be achieved, 15 years after the introduction of this interesting and promising technique [12].…”

Section: Discussionmentioning

confidence: 99%

Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation

Sgura

Arrotti

Magnavacchi³

et al. 2020

European Journal of Internal Medicine

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Background: Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) has been associated with worse outcomes. However, the impact on outcome of AKI in TAVI-patients is not well established. Methods: Inoperable patients with severe aortic stenosis (AS) undergoing TAVI in 2010-2018 were enrolled in this study. AKI and chronic kidney disease (CKD) were defined according to KDIGO guidelines. Patients were divided in two groups according to post-procedural AKI development. The primary endpoint was 30-day allcause mortality across the two groups. Results: A total of 373 patients (mean age 82.3 ± 6) were analyzed. Compared to non-AKI patients, those who developed AKI, were treated more frequently with trans-apical TAVI (66% vs 35%, p<0.01), with greater amount of contrast medium (200.6 vs 170.4 ml, p=0.02) and in presence of clinically significant peripheral artery disease (PAD, 33% vs 21%, p=0.04). Trans-apical access (OR 3.24, 95% CI 1.76-5.60, p<0.01) was associated with a 3-fold risk of AKI. After adjustment for age, Society of Thoracic Surgery risk score (STS), PAD, access type, EF and contrast medium amount, patients with AKI presented an increased risk of 30-day all-cause mortality (HR=1.25, 95%CI 1.09-1.69, p=0.008). Patients with CKD IV and V, who developed AKI, presented a 9-fold 30-day mortality risk (HR=9.71, 95% CI 2.40-39.2, p=0.001). Conclusion:In our analysis, AKI was a strong predictor of 30-day all-cause mortality. Particularly, patients with severe CKD with AKI showed the highest 30-day mortality risk. Thus, this group of patients might benefit from closer monitoring and specific kidney protection therapies.

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Section: Discussionmentioning

confidence: 99%

Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation

Sgura

Arrotti

Magnavacchi³

et al. 2020

European Journal of Internal Medicine

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“…CKD is a frequent condition among hospitalized patients due to its close association with increasing age and various co-morbidities. This relation is particularly strong in patients with cardiovascular diseases (CVD), including acute and chronic coronary syndrome (ACS and CCS), heart failure (HF), or atrial fibrillation (AF) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Several studies emphasized the bidirectional relation between renal function and cardiovascular outcomes [5,[20][21][22] as CVD is responsible for 40-50% of all deaths in nephropathic patients [5,23,24], and CKD, even in early stages, has been related to fatal and nonfatal cardiovascular events, regardless of traditional cardiovascular risk factors [25][26][27][28][29][30][31][32].…”

Section: Introductionmentioning

confidence: 99%

Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome

Malavasi

Valenti

Ruggerini

et al. 2022

JCM

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Background: This paper aims to evaluate the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and alternative equations and to assess their predictive power for all-cause mortality in unselected patients discharged alive from a cardiology ward. Methods: We retrospectively included patients admitted to our Cardiology Division independently of their diagnosis. The total population was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) categories, as follows: G1 (estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m2); G2 (eGFR 89–60 mL/min/1.73 m2); G3a (eGFR 59–45 mL/min/1.73 m2); G3b (eGFR 44–30 mL/min/1.73 m2); G4 (eGFR 29–15 mL/min/1.73 m2); G5 (eGFR <15 mL/min/1.73 m2). Cockcroft-Gault (CG), CG adjusted for body surface area (CG-BSA), Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study (BIS-1), and Full Age Spectrum (FAS) equations were also assessed. Results: A total of 806 patients were included. Good agreement was found between the CKD-EPI formula and CG-BSA, MDRD, BIS-1, and FAS equations. In subjects younger than 65 years or aged ≥85 years, CKD-EPI and MDRD showed the highest agreement (Cohen’s kappa (K) 0.881 and 0.588, respectively) while CG showed the lowest. After a median follow-up of 407 days, overall mortality was 8.2%. The risk of death was higher in lower eGFR classes (G3b HR4.35; 95%CI 1.05–17.80; G4 HR7.13; 95%CI 1.63–31.23; G5 HR25.91; 95%CI 6.63–101.21). The discriminant capability of death prediction tested with ROC curves showed the best results for BIS-1 and FAS equations. Conclusion: In our cohort, the concordance between CKD-EPI and other equations decreased with age, with the MDRD formula showing the best agreement in both younger and older patients. Overall, mortality rates increased with the renal function decreasing. In patients aged ≥75 years, the best discriminant capability for death prediction was found for BIS-1 and FAS equations.

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“…We assumed that quantification of GFR would yield better predictability based on previous observations and studies [9,15].…”

Section: Discussionmentioning

confidence: 99%

“…The utility of these scoring systems made them valuable for stratification of other cardiovascular fields, as well. We previously described the importance of incorporating kidney function and progressive renal failure into risk stratification [9]. In the current study, we used the less common R 2 CHA 2 DS 2 -VASc score to assess cardiovascular risk, which resulted in better predictability than did other scoring systems that did not include kidney function.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated its relevance in risk stratification of patients with ACS and other cardiovascular pathologies, regardless of the presence of AF [4][5][6][7][8]. We previously reported that high CHA 2 DS 2 VASC score is associated with adverse outcomes among patients with chest pain [2], and kidney function has an important contribution to the outcome of these patients [9].…”

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confidence: 99%

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Prediction of acute-coronary-syndrome using newly-defined R2-CHA2DS2-VASc score among patients with chest pain

Topaz

Ben-Zvi

Pereg

et al. 2021

Journal of Cardiology

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Impaired renal function is associated with adverse outcomes in patients with chest pain discharged from internal medicine wards

Cited by 5 publications

References 21 publications

Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation

Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation

Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome

Prediction of acute-coronary-syndrome using newly-defined R2-CHA2DS2-VASc score among patients with chest pain

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