Abstract
IntroductionAcute kidney injury is a common complication of percutaneous coronary intervention and has been associated with an increased risk of death and progressive chronic kidney disease. However, whether the timing of acute kidney injury after urgent percutaneous coronary intervention could be used to improve patient risk stratification is not known.MethodsWe conducted a retrospective cohort study in adults surviving an urgent percutaneous coronary intervention between 2008 and 2013 within Kaiser Permanente Northern California, a large integrated healthcare delivery system, to evaluate the impact of acute kidney injury during hospitalization at 12 (±6), 24 (±6) and 48 (±6) hours after urgent percutaneous coronary intervention and subsequent risks of adverse outcomes within the first year after discharge. We used multivariable Cox proportional hazards models with adjustment for a high-dimensional propensity score for developing acute kidney injury after percutaneous coronary intervention to examine the associations between acute kidney injury timing and all-cause death and worsening chronic kidney disease.ResultsAmong 7250 eligible adults undergoing urgent percutaneous coronary intervention, 306 (4.2%) had acute kidney injury at one or more of the examined time periods after percutaneous coronary intervention. After adjustment, acute kidney injury at 12 (±6) hours was independently associated with higher risks of death (adjusted hazard ratio [aHR] 3.55, 95% confidence interval [CI] 2.19–5.75) and worsening kidney function (aHR 2.40, 95% CI:1.24–4.63). Similar results were observed for acute kidney injury at 24 (±6) hours and death (aHR 3.90, 95% CI:2.29–6.66) and worsening chronic kidney disease (aHR 4.77, 95% CI:2.46–9.23). Acute kidney injury at 48 (±6) hours was associated with excess mortality (aHR 1.97, 95% CI:1.19–3.26) but was not significantly associated with worsening kidney function (aHR 0.91, 95% CI:0.42–1.98).ConclusionsTiming of acute kidney injury after urgent percutaneous coronary intervention may be differentially associated with subsequent risk of worsening kidney function but not death.
Highlights
Acute kidney injury is a common complication of percutaneous coronary intervention and has been associated with an increased risk of death and progressive chronic kidney disease
Timing of acute kidney injury after urgent percutaneous coronary intervention may be differentially associated with subsequent risk of worsening kidney function but not death
For the subgroup of patients with chronic kidney disease (CKD) before the Percutaneous coronary intervention (PCI), we examined post-discharge significant loss of kidney function, which we defined as a 50% relative decrease from pre-PCI estimated glomerular filtration rate (eGFR) using the CKD-EPI equation [24] or development of end-stage kidney disease (ESKD) defined as receipt of kidney replacement therapy based on a comprehensive health plan ESKD registry [25]
Summary
Acute kidney injury is a common complication of percutaneous coronary intervention and has been associated with an increased risk of death and progressive chronic kidney disease. There is a knowledge gap in the field about when and whether to intervene peri-PCI to try to prevent AKI, as well as uncertainty about optimal preventive or management approaches related to AKI It remains unclear whether early detection of AKI (e.g., within 12 to 24 h) after PCI could be used to improve patient risk stratification or inform provider decisions to try to reduce the risk of subsequent AKI-related outcomes. Further complicating this is that the definition of AKI used postPCI varies widely across studies and has not been restricted to increases in serum creatinine measurements that occur earlier than 48 h after PCI [11,12,13]. The development of AKI after PCI is known to have multiple risk factors and possible mechanisms, [14,15,16,17] and it is unclear if episodes of AKI occurring at different times after PCI are related to different causes and contribute variably to different natural histories and implications for future clinical outcomes
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