Rates of coronary angiography are inappropriately low in older cardiac patients who have chronic kidney disease

Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications.

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Contrast-induced acute kidney injury following coronary angiography: a cohort study of hospitalized patients with or without chronic kidney disease

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gft082 ◽

2013 ◽

Vol 28 (6) ◽

pp. 1463-1471 ◽

Cited By ~ 31

Author(s):

Javier A. Neyra ◽

Sunay Shah ◽

Roberta Mooney ◽

Gordon Jacobsen ◽

Jerry Yee ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cohort Study ◽

Kidney Disease ◽

Coronary Angiography ◽

Kidney Injury ◽

Hospitalized Patients

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180Myocardial perfusion imaging detected progressive myocardial ischemia in a chronic kidney disease patient with normal coronary angiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez137.002 ◽

2019 ◽

Vol 20 (Supplement_3) ◽

Author(s):

C Sioka ◽

K Papadimitropoulos ◽

T Al Boucharali ◽

K Sakelariou ◽

E Gkika ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Coronary Angiography ◽

Myocardial Ischemia ◽

Perfusion Imaging ◽

Chronic Kidney Disease Patient ◽

Disease Patient ◽

Normal Coronary Angiography

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TCT-30 Ultra-Low Contrast Coronary Angiography in Patients With Advanced Chronic Kidney Disease: Feasibility and Outcomes Compared With Conventional Angiography

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.057 ◽

2019 ◽

Vol 74 (13) ◽

pp. B30

Author(s):

Navdeep Bhatti ◽

Hussein Rahim ◽

Shmuel Chen ◽

Aaron Crowley ◽

Ajay Jayant Kirtane ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Coronary Angiography ◽

Conventional Angiography ◽

Advanced Chronic Kidney Disease ◽

Low Contrast

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Dickkopf-3 in the prediction of contrast media induced acute kidney injury

Journal of Nephrology ◽

10.1007/s40620-020-00910-1 ◽

2020 ◽

Author(s):

Felix S. Seibert ◽

Anja Heringhaus ◽

Nikolaos Pagonas ◽

Benjamin Rohn ◽

Frederic Bauer ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Coronary Angiography ◽

Predictive Accuracy ◽

Area Under The Curve ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Creatinine Ratio ◽

Creatinine Concentration

Abstract Background Dickkopf-3 (DKK3) has recently been discovered as a urinary biomarker for the prediction of acute kidney injury (AKI) after cardiac surgery. This finding needs to be confirmed for AKI in other clinical settings. The present study investigates whether DKK3 can predict contrast-induced AKI (CI-AKI). Methods We performed a prospective study in 490 patients undergoing coronary angiography. Primary endpoint was an increase in serum creatinine concentration ≥ 0.3 mg/dl within 72 h after the procedure. DKK3 was assessed < 24 h before coronary angiography. Predictive accuracy was assessed by receiver operating characteristic (ROC) curves. Results CI-AKI was observed in 30 (6.1%) patients, of whom 27 corresponded to stage I and 3 to stage II according to the Acute Kidney Injury Network (AKIN) criteria. Subjects who developed CI-AKI had a 3.8-fold higher urinary DKK3/creatinine ratio than those without CI-AKI (7.5 pg/mg [interquartile range [IQR] 1.2–1392.0] vs. 2.0 pg/mg [IQR 0.9–174.0]; p = 0.047). ROC analysis revealed an area under the curve (AUC) of 0.61. Among subjects without clinically overt chronic kidney disease (estimated glomerular filtration rate [eGFR] > 60 ml/min, urinary albumin creatinine ratio < 30 mg/g), the DKK3/creatinine ratio was 5.4-fold higher in those with subsequent CI-AKI (7.5 pg/mg [IQR 0.9–590.1] vs. 1.38 pg/mg [IQR 0.8–51.0]; p = 0.007; AUC 0.62). Coronary angiography was associated with a 43 times increase in the urinary DKK3/creatinine ratio. Conclusions Urinary DKK3 is an independent predictor of CI-AKI even in the absence of overt chronic kidney disease (CKD). The study thereby expands the findings on DKK3 in the prediction of postoperative loss of kidney function to other entities of AKI. Graphic abstract

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Contemporary National Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Patients with Prior Chronic Kidney Disease and End-Stage Renal Disease

Journal of Clinical Medicine ◽

10.3390/jcm9113702 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3702

Author(s):

Saraschandra Vallabhajosyula ◽

Lina Ya’Qoub ◽

Vinayak Kumar ◽

Dhiran Verghese ◽

Anna V. Subramaniam ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Coronary Angiography ◽

Hospital Mortality ◽

End Stage Renal Disease ◽

Ckd Stage ◽

Stage Renal Disease ◽

End Stage

Background: There are limited data on acute myocardial infarction with cardiogenic shock (AMI-CS) stratified by chronic kidney disease (CKD) stages. Objective: To assess clinical outcomes in AMI-CS stratified by CKD stages. Methods: A retrospective cohort of AMI-CS during 2005–2016 from the National Inpatient Sample was categorized as no CKD, CKD stage-III (CKD-III), CKD stage-IV (CKD-IV) and end-stage renal disease (ESRD). CKD-I/II were excluded. Outcomes included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS). We also evaluated acute kidney injury (AKI) and acute hemodialysis in non-ESRD admissions. Results: Of 372,412 AMI-CS admissions, CKD-III, CKD-IV and ESRD comprised 20,380 (5.5%), 7367 (2.0%) and 18,109 (4.9%), respectively. Admissions with CKD were, on average, older, of the White race, bearing Medicare insurance, of a lower socioeconomic stratum, with higher comorbidities, and higher rates of acute organ failure. Compared to the cohort without CKD, CKD-III, CKD-IV and ESRD had lower use of coronary angiography (72.7%, 67.1%, 56.9%, 61.1%), PCI (53.7%, 43.8%, 38.4%, 37.6%) and MCS (47.9%, 38.3%, 33.3%, 34.2%), respectively (all p < 0.001). AKI and acute hemodialysis use increased with increase in CKD stage (no CKD–38.5%, 2.6%; CKD-III–79.1%, 6.5%; CKD-IV–84.3%, 12.3%; p < 0.001). ESRD (adjusted odds ratio [OR] 1.25 [95% confidence interval {CI} 1.21–1.31]; p < 0.001), but not CKD-III (OR 0.72 [95% CI 0.69–0.75); p < 0.001) or CKD-IV (OR 0.82 [95 CI 0.77–0.87] was predictive of in-hospital mortality. Conclusions: CKD/ESRD is associated with lower use of evidence-based therapies. ESRD was an independent predictor of higher in-hospital mortality in AMI-CS.

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