Prevalence and mortality of transient acute kidney injury within 48 h, as new subtype, following coronary angiography: a cohort study

Abstract Background: Acute kidney injury (AKI) is a frequent complication in cardiac arrest survivors and associated with adverse outcome. It remains unclear whether the incidence of AKI increases after the post-cardiac arrest administration of contrast for coronary angiography and whether this depends on timing of contrast administration. Aim of this study was to investigate whether early angiography is associated with increased development of AKI compared to deferred angiography in out-of-hospital cardiac arrest (OHCA) survivors.Methods: In this retrospective multicenter cohort study we investigated whether early angiography (within 2 h) after OHCA was non-inferior to delayed/no angiography regarding the development of AKI. We used an absolute difference of 5% as the non-inferiority margin. Primary non-inferiority analysis was done by calculating the risk difference with its 90% confidence interval (CI) using a generalized linear model for a binary outcome and the identity link-function. As a sensitivity analysis we repeated the primary analysis using propensity score matching.Results: A total of 2151 patients were included in the study from 2009 until 2018, of which 1062 patients were treated with early coronary angiography and 1089 patients with delayed or no angiography. The proportion that developed AKI after OHCA was 17.8% in the early angiography group and 21.5% in the deferred angiography group. Risk difference was -3.7% with 90% CI ranging from -6.7% to -0.7%, indicating non-inferiority of early angiography at the prespecified margin of 5%. As sensitivity analysis we repeated the primary analysis using propensity score matching, which accordingly showed non-inferiority of early angiography. A multivariable model was built to identify predictors of acute kidney injury. The factors time to return of spontaneous circulation (odds ratio [OR] 1.10, 95% CI 1.05–1.15, p<0.001) and baseline creatinine (OR 1.05, 95% CI 1.03–1.07, p<0.001) were found to be independently associated with the development of AKI.Conclusions: Although AKI occurred in approximately 20% of OHCA patients, we found that early angiography had an equal AKI incidence as a delayed or no angiography strategy. The present results implicate that it is safe to perform early coronary angiography with respect to the risk of developing AKI after OHCA.

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Nomogram for contrast-induced acute kidney injury in patients with chronic kidney disease undergoing coronary angiography in China: a cohort study

BMJ Open ◽

10.1136/bmjopen-2020-037256 ◽

2020 ◽

Vol 10 (5) ◽

pp. e037256

Author(s):

Li Lei ◽

Yan Xue ◽

Zhaodong Guo ◽

Bowen Liu ◽

Yibo He ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cohort Study ◽

Kidney Disease ◽

Coronary Angiography ◽

Southern China ◽

Bootstrap Method ◽

Area Under The Curve ◽

Kidney Injury ◽

Discriminative Power

ObjectivesTo establish a nomogram for contrast-induced acute kidney injury (CI-AKI) risk assessment among patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).DesignProspective observational cohort study.SettingSouthern China.InterventionsNone.Participants643 consecutive patients with CKD (defined as estimated glomerular filtration rate calculated by Modification of Diet in Renal Disease formula <60 mL/min/1.73 mm2) were enrolled.Outcome measuresThe end point was CI-AKI defined as serum creatinine elevation ≥0.5 mg/dL or 25% from baseline within the first 48–72 hours following contrast exposure.Predictors of CI-AKI were selected by multivariable logistic regression and stepwise approach. A nomogram based on these predictors was constructed and compared with the classic Mehran Score. For validation, a bootstrap method (1000 times) was performed.ResultsThe nomogram including age, weight, heart rate, hypotension, PCI and β-blocker demonstrated a better predictive value than the classic Mehran Score (area under the curve: 0.78 vs 0.71, p=0.024), as well as a well-fitted calibration curve (χ2=12.146, p=0.145). Validation through the bootstrap method (1000 times) also indicated a good discriminative power (adjusted C-statistic: 0.76).ConclusionsWith fewer predictors and higher discriminative power, the present nomogram may be a simple and reliable tool to identify patients with CKD at risk of CI-AKI, whereas further external validations are needed.

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