Implications of Malnutrition on Contrast-Associated Acute Kidney Injury in Young and Old Patients Undergoing Percutaneous Coronary Intervention: A Multicenter Prospective Cohort

Abstract

BackgroundThe relationship between malnutrition and the risk of contrast-associated acute kidney injury (CA-AKI) and the resulting prognosis in patients undergoing percutaneous coronary intervention (PCI) is still not well known.MethodsPatients undergoing PCI were consecutively enrolled in a multicenter study in China (NCT01402232), categorized by nutritional status (non-malnutrition, malnutrition) based on two different cut-off values (i.e., traditional threshold and the best cut-off value based on the receiver operating characteristic (ROC) curve) for the controlling nutritional status (CONUT) score. The primary endpoint was CA-AKI, diagnosed as a rise in serum creatinine >0.3 mg/dl or >50% than the baseline level occurring within 48 h after the intervention. The secondary endpoint was all-cause mortality. The relationships of malnutrition, CA-AKI, and all-cause mortality were examined using multivariate-adjusted logistic and Cox regression analyses, respectively.ResultsAmong 2,083 patients undergoing PCI (age: 62.8 ± 11.1 years; 79.0% men), 1,258 (60.4%) were malnourished. During hospitalization, 80 (3.8%) patients developed CA-AKI events. The incidence of CA-AKI in patients who did not have malnutrition (the non-malnutrition group) and those who did have malnutrition (the malnutrition group) was 1.7% and 5.25%, respectively. Patients with malnutrition had a 2-fold increased adjusted risk of CA-AKI compared to those with no malnutrition [adjusted odds ratio (aOR) (95% confidence interval CI): 2.41 (1.22 to 5.22)]. Malnutrition was associated with a 3-fold increased adjusted risk of CA-AKI in patients aged ≤ 75 years [N = 1,791, aOR (95% CI): 3.39 (1.46–9.25)]. Malnourished patients with CA-AKI had a higher risk of all-cause mortality than the others. Similar results were observed in the grouping of Supplemental Analyses based on the optimal cut-off value of the CONUT score identified by the ROC curve.ConclusionsMalnutrition is strongly associated with an increased risk of CA-AKI in both young and old patients undergoing PCI. Malnourished patients with CA-AKI had a significantly higher risk of all-cause mortality. Further studies are needed to prospectively assess the efficacy of nutritional interventions on outcomes in patients undergoing PCI.

Association of Malnutrition with Risk of Acute Kidney Injury: A Systematic Review and Meta-Analysis

“…The population of the original studies was mainly from China [ 10 – 12 , 17 – 21 , 23 , 25 , 28 ]; three were from Turkey [ 16 , 22 , 24 , 26 , 27 ], and one was from America [ 15 ]. Among the 17 studies, 11 studies included patients undergoing coronary angiography (CAG) or percutaneous coronary angiography [ 11 , 12 , 16 , 17 , 19 , 21 , 23 – 26 , 28 ], two included patients undergoing coronary artery bypass [ 22 , 27 ], one was related to pediatric severe sepsis [ 15 ], and three included patients with other diseases [ 10 , 18 , 20 ]. Malnutrition was mainly assessed using the CONUT score, geriatric nutritional risk index, Modified Nutrition Risk in Critically Ill Patients score, PNI, and NRS-2002.…”

“…In addition, malnourished patients with CA-AKI had a significantly higher risk of all-cause mortality than patients with malnutrition. A multicenter prospective cohort of 2,083 patients undergoing PCI demonstrated that malnourished patients with CA-AKI had a higher risk of all-cause mortality than did those without [ 19 ]. Therefore, clinicians should assess and monitor the nutritional status of patients undergoing PCI.…”

“…1. A total of 273,315 individuals were included in three cross-sectional studies [12,15,16], fve prospective cohort studies [17][18][19][20][21], and nine retrospective cohort studies [10,11,[22][23][24][25][26][27][28]. Te population of the original studies was mainly from China [10-12, 17-21, 23, 25, 28]; three were from Turkey [16,22,24,26,27], and one was from America [15].…”