Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention

Xiaoqi Wei,Haoming He,Weiping Zheng,Hanchuan Chen,Chen He,Jie Yang,Zhebin You,Kaiyang Lin,Feng Jiang

doi:10.1007/s10157-021-02061-4

Abstract

BackgroundThis study aimed to investigate the connection between malnutrition evaluated by the Controlling Nutritional Status (CONUT) score and the risk of contrast-associated acute kidney injury (CA-AKI) in elderly patients who underwent percutaneous coronary intervention (PCI).MethodsA total of 1308 patients aged over 75 years undergoing PCI was included. Based on the CONUT score, patients were assigned to normal (0–1), mild malnutrition (2–4), moderate-severe malnutrition group (≥ 5). The primary outcome was CA-AKI (an absolute increase in ≥ 0.3 mg/dL or ≥ 50% relative serum creatinine increase 48 h after contrast medium exposure).ResultsOverall, the incidence of CA-AKI in normal, mild, moderate-severe malnutrition group was 10.8%, 11.0%, and 27.2%, respectively (p < 0.01). Compared with moderate-severe malnutrition group, the normal group and the mild malnutrition group showed significant lower risk of CA-AKI in models adjusting for risk factors for CA-AKI and variables in univariate analysis (odds ratio [OR] = 0.48, 95% confidence interval [CI]: 0.26–0.89, p = 0.02; OR = 0.46, 95%CI: 0.26–0.82, p = 0.009, respectively). Furthermore, the relationship were consistent across the subgroups classified by risk factors for CA-AKI except anemia. The risk of CA-AKI related with CONUT score was stronger in patients with anemia. (overall interaction p by CONUT score = 0.012).ConclusionModerate-severe malnutrition is associated with higher risk of CA-AKI in elderly patients undergoing PCI.

Highlights

With the development of coronary angiography, more and more elderly patients with coronary heart disease receive percutaneous coronary intervention (PCI)
We aim to evaluate the predictive value of the Controlling Nutritional Status (CONUT) score for contrast-associated acute kidney injury (CA-AKI)
MI myocardial infarction, PCI percutaneous coronary intervention, ACEI angiotensin-converting enzyme inhibitor, ARB angiotensin receptor blocker, eGFR estimated glomerular filtration rate, ALB albumin, WBC white blood cell, HGB hemoglobin, HCT hematocrit and the group of CONUT score 2–4 remained significant lower risk of CA-AKI in elderly patients after PCI, compared with the group of CONUT score ≥ 5 (Table 3)

Summary

Introduction

With the development of coronary angiography, more and more elderly patients with coronary heart disease receive percutaneous coronary intervention (PCI). Elderly patients with coronary diseases who underwent percutaneous coronary intervention (PCI), were more likely to develop contrast-associated acute kidney injury (CA-AKI) than general population [1]. Malnutrition, which is high present in elderly patients [3, 4], is a predisposing factor for AKI [5, 6]. The. This study aimed to investigate the connection between malnutrition evaluated by the Controlling Nutritional Status (CONUT) score and the risk of contrast-associated acute kidney injury (CA-AKI) in elderly patients who underwent percutaneous coronary intervention (PCI). Based on the CONUT score, patients were assigned to normal (0–1), mild malnutrition (2–4), moderate-severe malnutrition group (≥ 5). Results Overall, the incidence of CA-AKI in normal, mild, moderate-severe malnutrition group was 10.8%, 11.0%, and 27.2%, respectively (p < 0.01). Conclusion Moderate-severe malnutrition is associated with higher risk of CA-AKI in elderly patients undergoing PCI

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