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.
Highlights
Contrast-associated acute kidney injury (CA-AKI) is a major complication of percutaneous coronary intervention (PCI) and is associated with poor prognosis [1, 2]
Proteincaloric malnutrition is related to kidney hemodynamic changes, the reduction of renal blood flow, glomerular filtration rate, and the ability of renal tubules to excrete acid [10, 11], which are involved in the physiological mechanisms that occur during CA-AKI
Compared with the non-malnutrition group, malnourished patients were older, but there was no significant difference in the proportion of sex, diabetes mellitus (DM), and smoking
Summary
Contrast-associated acute kidney injury (CA-AKI) is a major complication of percutaneous coronary intervention (PCI) and is associated with poor prognosis [1, 2]. The incidence of CA-AKI in patients undergoing PCI ranged from 6 to 18% [3–5]. CA-AKI is highly related to neutrophils and albumin, which are well-known biomarkers of inflammation [8, 9], and is affected by malnutrition. Proteincaloric malnutrition is related to kidney hemodynamic changes, the reduction of renal blood flow, glomerular filtration rate, and the ability of renal tubules to excrete acid [10, 11], which are involved in the physiological mechanisms that occur during CA-AKI. The 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
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