Steven D Weisbord1, Paul M Palevsky2, James S Kaufman3, Hongsheng Wu4, Maria Androsenko4, Ryan E Ferguson4, Chirag R Parikh5, Deepak L Bhatt6, Martin Gallagher7. 1. Renal Section, Medicine Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: weisbordsd@upmc.edu. 2. Renal Section, Medicine Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 3. Veterans Affairs Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Division of Nephrology, New York University School of Medicine, New York, New York. 4. Veterans Affairs Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts. 5. Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland. 6. Brigham and Women's Hospital Heart and Vascular Center, Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, Massachusetts. 7. George Institute for Global Health, Sydney, Australia.
Abstract
BACKGROUND: Contrast-associated acute kidney injury (CA-AKI) associates with an increased relative risk for serious adverse outcomes. However, the magnitude of this risk and the incidence of clinically significant CA-AKI derived from analyses of large cohorts with prospective assessment of CA-AKI and subsequent outcomes are unknown. OBJECTIVES: This study sought to characterize the relative risk for and incidence of serious adverse outcomes following the development of CA-AKI and to explore whether CA-AKI mediates the association of pre-angiography estimated glomerular filtration rate with adverse outcomes. METHODS: Among 4,418 participants in the PRESERVE (Prevention of Serious Adverse Outcomes Following Angiography) trial with comprehensive baseline and outcome data, we assessed whether CA-AKI was associated with the 90-day outcome comprising death, need for dialysis, or persistent impairment in kidney function. We calculated the incidence of clinically significant CA-AKI (i.e., proportion of patients who developed CA-AKI and the 90-day outcome) and examined whether CA-AKI was a mediator of the association of baseline kidney function with the 90-day outcome. RESULTS: CA-AKI was associated with an increased relative risk for 90-day death, need for dialysis, or persistent kidney impairment (odds ratio: 3.93; 95% confidence interval: 2.82 to 5.49; p < 0.0001). The incidence of clinically significant CA-AKI was 1.2% (53 of 4,418 patients). CA-AKI was not a mediator of the association of pre-angiography estimated glomerular filtration rate with the primary outcome. CONCLUSIONS: Whereas CA-AKI is associated with an increased relative risk of serious, adverse 90-day outcomes, the incidence of clinically significant CA-AKI is very low. CA-AKI does not mediate the association of the pre-angiography estimated glomerular filtration rate with these outcomes. Published by Elsevier Inc.
RCT Entities:
BACKGROUND: Contrast-associated acute kidney injury (CA-AKI) associates with an increased relative risk for serious adverse outcomes. However, the magnitude of this risk and the incidence of clinically significant CA-AKI derived from analyses of large cohorts with prospective assessment of CA-AKI and subsequent outcomes are unknown. OBJECTIVES: This study sought to characterize the relative risk for and incidence of serious adverse outcomes following the development of CA-AKI and to explore whether CA-AKI mediates the association of pre-angiography estimated glomerular filtration rate with adverse outcomes. METHODS: Among 4,418 participants in the PRESERVE (Prevention of Serious Adverse Outcomes Following Angiography) trial with comprehensive baseline and outcome data, we assessed whether CA-AKI was associated with the 90-day outcome comprising death, need for dialysis, or persistent impairment in kidney function. We calculated the incidence of clinically significant CA-AKI (i.e., proportion of patients who developed CA-AKI and the 90-day outcome) and examined whether CA-AKI was a mediator of the association of baseline kidney function with the 90-day outcome. RESULTS: CA-AKI was associated with an increased relative risk for 90-day death, need for dialysis, or persistent kidney impairment (odds ratio: 3.93; 95% confidence interval: 2.82 to 5.49; p < 0.0001). The incidence of clinically significant CA-AKI was 1.2% (53 of 4,418 patients). CA-AKI was not a mediator of the association of pre-angiography estimated glomerular filtration rate with the primary outcome. CONCLUSIONS: Whereas CA-AKI is associated with an increased relative risk of serious, adverse 90-day outcomes, the incidence of clinically significant CA-AKI is very low. CA-AKI does not mediate the association of the pre-angiography estimated glomerular filtration rate with these outcomes. Published by Elsevier Inc.
Authors: David M Safley; Adam C Salisbury; Thomas T Tsai; Eric A Secemsky; Kevin F Kennedy; R Kevin Rogers; Faisal Latif; Nicolas W Shammas; Lawrence Garcia; Matthew A Cavender; Kenneth Rosenfield; Anand Prasad; John A Spertus Journal: JACC Cardiovasc Interv Date: 2021-02-08 Impact factor: 11.195
Authors: Ali O Malik; Amit Amin; Kevin Kennedy; Mohammed Qintar; Ali Shafiq; Roxana Mehran; John A Spertus Journal: Am Heart J Date: 2021-01-25 Impact factor: 4.749
Authors: Caroline Liu; Maria K Mor; Paul M Palevsky; James S Kaufman; Heather Thiessen Philbrook; Steven D Weisbord; Chirag R Parikh Journal: Clin J Am Soc Nephrol Date: 2020-08-24 Impact factor: 8.237