Contrast-Induced Acute Kidney Injury and Risk of Adverse Clinical Outcomes After Coronary Angiography

Background Fibroblast growth factor (FGF)-23 levels rise as kidney function declines. Whether elevated FGF-23 levels are associated with an increased risk for contrast-associated acute kidney injury (CA-AKI) and major adverse cardiovascular events (MACE) in patients undergoing coronary angiography remain uncertain. Methods In total, 492 patients receiving coronary angiography were enrolled. Their serum FGF-23 levels were measured before administration of contrast media. The occurrence of CA-AKI was defined as a rise in serum creatinine of 0.5 mg/dL or a 25% increase from the baseline value within 48 h after the procedure. All patients were followed up for at least 1 year or until the occurrence of MACE including death, nonfatal myocardial infarction (MI), and ischemic stroke. Results Overall, CA-AKI occurred in 41 (8.3%) patients. During a median follow-up of 2.6 years, there were 24 deaths, 3 nonfatal MIs, and 7 ischemic strokes. Compared with those in the lowest FGF-23 tertile, individuals in the highest FGF-23 tertile had a significantly higher incidence of CA-AKI (P < 0.001) and lower incidence of MACE-free survival (P = 0.001). In multivariate regression analysis, higher FGF-23 level was found to be independently associated with a graded risk for CA-AKI (OR per doubling, 1.90; 95% CI 1.48–2.44) and MACE (HR per doubling, 1.25; 95% CI 1.02–1.52). Conclusions Elevated FGF-23 levels were associated with an increased risk for CA-AKI and future MACE among patients undergoing coronary angiography. FGF-23 may play a role in early diagnosis of CA-AKI and predicting clinical outcomes after coronary angiography.

Download Full-text

543-P: A Clinical, Proteomics and Artificial Intelligence-Driven Model to Predict Acute Kidney Injury in Diabetic Patients Undergoing Coronary Angiography—Results from the Catheter Sampled Blood Archive in Cardiovascular Diseases Study

Diabetes ◽

10.2337/db19-543-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 543-P

Author(s):

NASRIEN E. IBRAHIM ◽

CIAN P. MCCARTHY ◽

SHREYA SHRESTHA ◽

HANNA GAGGIN ◽

RENATA MUKAI ◽

...

Keyword(s):

Artificial Intelligence ◽

Acute Kidney Injury ◽

Cardiovascular Diseases ◽

Coronary Angiography ◽

Kidney Injury ◽

Clinical Proteomics ◽

Diabetic Patients

Download Full-text

Faculty Opinions recommendation of Acute kidney injury following coronary angiography is associated with a long-term decline in kidney function.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4998957.4932056 ◽

2010 ◽

Author(s):

Ashita Tolwani ◽

Keith Wille

Keyword(s):

Acute Kidney Injury ◽

Coronary Angiography ◽

Kidney Function ◽

Kidney Injury

Download Full-text

Faculty of 1000 evaluation for Does ascorbic acid protect against contrast induced- acute kidney injury in patients undergoing coronary angiography - a systematic review with meta-analysis of randomized controlled trials.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718095571.793485184 ◽

2013 ◽

Author(s):

Mauricio Cohen ◽

Kamalkumar Kolappa

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Ascorbic Acid ◽

Coronary Angiography ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Kidney Injury ◽

Controlled Trials ◽

Randomized Controlled

Download Full-text

Angiotensin-Converting Enzyme Inhibitors and Contrast-Associated Acute Kidney Injury After Coronary Angiography and Intervention

American Journal of Cardiovascular Drugs ◽

10.1007/s40256-020-00455-5 ◽

2020 ◽

Author(s):

Melissa Wasilewski ◽

Sumon Roy ◽

Nilang G. Patel ◽

Ion S. Jovin

Keyword(s):

Acute Kidney Injury ◽

Coronary Angiography ◽

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Kidney Injury ◽

Angiotensin Converting Enzyme Inhibitors ◽

Converting Enzyme ◽

Converting Enzyme Inhibitors

Download Full-text

A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.2554 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Lei ◽

Y He ◽

Z Guo ◽

B Liu ◽

J Liu ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Acute Kidney Injury ◽

Coronary Angiography ◽

Prediction Models ◽

Validation Cohort ◽

Kidney Injury ◽

Class Ii ◽

Functional Class ◽

Killip Class

Abstract Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available. Objectives We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed. Figure 1 Funding Acknowledgement Type of funding source: None

Download Full-text

Adverse clinical outcomes associated with RAAS inhibitor discontinuation: analysis of over 400 000 patients from the UK Clinical Practice Research Datalink (CPRD)

Clinical Kidney Journal ◽

10.1093/ckj/sfab029 ◽

2021 ◽

Author(s):

Toby J L Humphrey ◽

Glen James ◽

Eric T Wittbrodt ◽

Donna Zarzuela ◽

Thomas F Hiemstra

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Clinical Practice ◽

Clinical Outcomes ◽

Kidney Injury ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Ckd Stage ◽

First Occurrence ◽

Baseline Characteristics

Abstract Background Users of guideline-recommended renin–angiotensin–aldosterone system (RAAS) inhibitors may experience disruptions to their treatment, e.g. due to hyperkalaemia, hypotension or acute kidney injury. The risks associated with treatment disruption have not been comprehensively assessed; therefore, we evaluated the risk of adverse clinical outcomes in RAAS inhibitor users experiencing treatment disruptions in a large population-wide database. Methods This exploratory, retrospective analysis utilized data from the UK’s Clinical Practice Research Datalink, linked to Hospital Episodes Statistics and the Office for National Statistics databases. Adults (≥18 years) with first RAAS inhibitor use (defined as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) between 1 January 2009 and 31 December 2014 were eligible for inclusion. Time to the first occurrence of adverse clinical outcomes [all-cause mortality, all-cause hospitalization, cardiac arrhythmia, heart failure hospitalization, cardiac arrest, advancement in chronic kidney disease (CKD) stage and acute kidney injury] was compared between RAAS inhibitor users with and without interruptions or cessations to treatment during follow-up. Associations between baseline characteristics and adverse clinical outcomes were also assessed. Results Among 434 027 RAAS inhibitor users, the risk of the first occurrence of all clinical outcomes, except advancement in CKD stage, was 8–75% lower in patients without interruptions or cessations versus patients with interruptions/cessations. Baseline characteristics independently associated with increased risk of clinical outcomes included increasing age, smoking, CKD, diabetes and heart failure. Conclusions These findings highlight the need for effective management of factors associated with RAAS inhibitor interruptions or cessations in patients for whom guideline-recommended RAAS inhibitor treatment is indicated.

Download Full-text