Abstract
BackgroundContrast-induced acute kidney injury (CI-AKI) is a common complication with poor outcomes following coronary angiography (CAG) or percutaneous coronary intervention (PCI). However, no study has explored the population attributable risks (PARs) of the CI-AKI risk factors. Therefore, we aimed to identify the independent risk factors of CI-AKI and estimate their PARs.MethodsWe analyzed 3450 consecutive patients undergoing CAG/PCI from a prospective cohort in Guangdong Provincial People’s Hospital. CI-AKI was defined as a serum creatinine elevation ≥50% or 0.3 mg/dL from baseline within the first 48 to 72 h after the procedure. Independent risk factors for CI-AKI were evaluated through stepwise approach and multivariable logistic regression analysis, and those that are potentially modifiable were of interest. PARs of independent risk factors were calculated with their odds ratios and prevalence among our cohort.ResultsThe overall incidence of CI-AKI was 7.19% (n = 248), which was associated with increased long-term mortality. Independent risk factors for CI-AKI included heart failure (HF) symptoms, hypoalbuminemia, high contrast volume, hypotension, hypertension, chronic kidney disease stages, acute myocardial infarction and age > 75 years. Among the four risk factors of interest, the PAR of HF symptoms was the highest (38.06%), followed by hypoalbuminemia (17.69%), high contrast volume (12.91%) and hypotension (4.21%).ConclusionsThese modifiable risk factors (e.g., HF symptoms, hypoalbuminemia) could be important and cost-effective targets for prevention and treatment strategies to reduce the risk of CI-AKI. Intervention studies targeting these risk factors are needed.
Highlights
Contrast-induced acute kidney injury (CI-AKI) is a common complication with poor outcomes following coronary angiography (CAG) or percutaneous coronary intervention (PCI)
Our study was the first one to estimate the proportion of CI-AKI attributed to four risk factors (HF symptoms, hypoalbuminemia, hypotension, and high contrast volume) that are commonly documented in cardiovascular patients and are potentially modifiable with populationlevel changes in operation strategy and pharmacological therapy
Our findings suggest that a substantial proportion (17.69%) of CI-AKI can be attributed to hypoalbuminemia alone, indicating that interventions that improve hypoalbuminemia have the potential to eliminate a large proportion of CI-AKI in patients undergoing CAG
Summary
Contrast-induced acute kidney injury (CI-AKI) is a common complication with poor outcomes following coronary angiography (CAG) or percutaneous coronary intervention (PCI). No study has explored the population attributable risks (PARs) of the CI-AKI risk factors. We aimed to identify the independent risk factors of CI-AKI and estimate their PARs. Contrast-induced acute kidney injury (CI-AKI) is a common complication of coronary diagnostic and interventional procedures that is significantly associated with the composite endpoint of major adverse renal and cardiovascular events (MARCE) [1,2,3]. Screening and identifying patients at risk of CI-AKI would and accurately allow prophylactic intervention in those at high risk. Research on the prevention of CI-AKI has focused on the use of intravenous fluids, renal replacement therapies (RRTs), and pharmaceutical agents. Clinicians do not have enough information to improve evidence-based screening and prevention efforts
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