The Real Importance of Pre-Existing Comorbidities on Long-Term Mortality after Acute Kidney Injury

Introduction Serum cystatin C measurements as an early biomarker of acute kidney injury (AKI) is gaining acceptance as studies confirm and define its usefulness. The aim of this study is to determine whether increase in serum cystatin C has an impact on long-term mortality, independently from the presence of the kidney injury itself.Materials and methods A retrospective study (20-month follow-up) was conducted in 173 not selected hospitalized patients. According to serum cystatin C concentrations, patients were stratified in risk classes by quartiles (≥0.55 and <1 mg/L; ≥1 and <1.17 mg/L; ≥1.17 and 1.57 mg/L; ≥1.57 and ≤5.29 mg/L). We compared the association of cystatin C levels with the risk for long-term mortality, after adjustment for age, sex, race and heart failure risk factors.Results A relationship with higher serum levels of cystatin C and mortality was found in patients with and without AKI, being stronger in patients without AKI. After multivariate adjustment, the highest quartile of cystatin C (>1.5 mg/L) was associated with a lower risk for long-term mortality. The statistical analysis (Cox regression) of the independent variables as far as mortality is concerned confirmed the significance of our result (RR 3.60; IC 1.73–7.48; p = 0.001).Conclusions In summary, elevated serum cystatin C level (>1.5 mg/L) was strongly and independently associated with negative clinical outcomes such as mortality and cardiovascular events, independently from the kidney injury itself. The dosage of cystatin C might play an important role in clinical practice for the assessment of cardiovascular risk stratification.

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The Incidence of Acute Kidney Injury Following Lung Transplantation Performed on Cardiopulmonary Bypass; Risk Factors, Effect on Short and Long-Term Mortality

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2019.01.1068 ◽

2019 ◽

Vol 38 (4) ◽

pp. S419 ◽

Cited By ~ 1

Author(s):

C. Carlheim ◽

A.M. Holm ◽

J.F. Bugge

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiopulmonary Bypass ◽

Lung Transplantation ◽

Kidney Injury ◽

Short And Long Term ◽

Long Term Mortality

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A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01778-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhubin Lun ◽

Li Lei ◽

Dianhua Zhou ◽

Ming Ying ◽

Liwei Liu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Angiography ◽

Cox Regression ◽

Kidney Injury ◽

Diabetic Patients ◽

Patients With Diabetes ◽

Long Term Prognosis ◽

Population Attributable Risks ◽

Long Term Mortality

Abstract Background The definitions of contrast-associated acute kidney injury (CA-AKI) are diverse and have different predictive effects for prognosis, which are adverse for clinical practice. Few articles have discussed the relationship between these definitions and long-term prognosis in patients with diabetes. Methods A total of 1154 diabetic patients who were undergoing coronary angiography (CAG) were included in this study. Two definitions of CA-AKI were used: CA-AKIA was defined as an increase ≥ 0.3 mg/dl or > 50% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIB was defined as an increase ≥ 0.5 mg/dl or > 25% in SCr from baseline within 72 h after CAG. We used Cox regression to evaluate the association of these two CA-AKI definitions with long-term mortality and calculate the population attributable risks (PARs) of different definitions for long-term prognosis. Results During the median follow-up period of 7.4 (6.2–8.2) years, the overall long-term mortality was 18.84%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 36.73% and 28.86%, respectively. We found that CA-AKIA (HR: 2.349, 95% CI 1.570–3.517, p = 0.001) and CA-AKIB (HR: 1.608, 95% CI 1.106–2.339, p = 0.013) were associated with long-term mortality. The PARs were the highest for CA-AKIA (31.14%), followed by CA-AKIB (14.93%). Conclusions CA-AKI is a common complication in diabetic patients receiving CAG. The two CA-AKI definitions are significantly associated with a poor long-term prognosis, and CA-AKIA, with the highest PAR, needs more clinical attention.

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