Jonghanne Park1, Alexandre Mebazaa2, Jin Joo Park3, Tae-Min Rhee4, Hyun-Ah Park5, Ga Yeon Lee6, Jin-Oh Choi6, Eun-Seok Jeon6, Sang Eun Lee7, Hyun-Jai Cho4, Hae-Young Lee4, Byung-Hee Oh8, Dong-Ju Choi3. 1. Northwestern Medicine Developmental Therapeutics Institute, Chicago, IL, USA. 2. Department of Anesthesiology and Intensive Care Medicine, Saint Louis-Lariboisière University Hospitals, University Paris Diderot, Paris, France. 3. Cardiovascular Center & Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 4. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. 5. Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea. 6. Department of Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea. 7. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 8. Mediplex Sejong Hospital, Incheon, Korea.
Abstract
Background and Objectives: Heart failure (HF) is a well-known risk factor for contrast-induced acute kidney injury (CI-AKI). We sought to evaluate the risk factors and prognostic impact of CI-AKI in patients with AHF who undergo coronary angiography (CAG). Methods: A total 594 patients with AHF underwent CAG from May 1, 2011 to December 31, 2013. CI-AKI was defined as an increase ≥25% or ≥0.5 mg/dL in serum creatinine at 48 hours after CAG or the initiation of dialysis after CAG. The deviation of body weight on CAG day from the dry weight (ΔBWTCAG, %) was calculated for each patient. Results: Overall, CI-AKI was observed in 24.7% of patients. Patients with CI-AKI had higher in-hospital death (16.3% vs. 5.1%, p<0.001; relative risk [RR], 2.50; 95% confidence interval [CI], 1.45-4.31) and 1-year post-discharge death (38.1% vs. 17.4%, p<0.001; hazard ratio, 2.16; 95% CI, 1.40-3.34) than those without CI-AKI. Patients with CI-AKI had greater ΔBWTCAG than those without CI-AKI (5.5±5.7% vs. 3.7±4.0%, p<0.001). A J-shaped association between the risk of CI-AKI and ΔBWTCAG was noted. In patients with weight excess (n=179), an increase of ΔBWT by 1% was associated with 9% (RR, 1.09; 95% CI, 1.03-1.16), while in patients with weight deficiency (n=86), a decrease of ΔBWT by 1% was associated with 11% increased risk for CI-AKI (RR, 1.11; 95% CI, 1.05-1.17). Conclusions: In AHF patients undergoing CAG CI-AKI is common and associated with worse clinical outcomes. Achieving optimum body weight before CAG may reduce the risk of CI-AKI. Trial Registration: ClinicalTrials.gov Identifier: NCT01389843.
Background and Objectives: Heart failure (HF) is a well-known risk factor for contrast-induced acute kidney injury (CI-AKI). We sought to evaluate the risk factors and prognostic impact of CI-AKI in patients with AHF who undergo coronary angiography (CAG). Methods: A total 594 patients with AHF underwent CAG from May 1, 2011 to December 31, 2013. CI-AKI was defined as an increase ≥25% or ≥0.5 mg/dL in serum creatinine at 48 hours after CAG or the initiation of dialysis after CAG. The deviation of body weight on CAG day from the dry weight (ΔBWTCAG, %) was calculated for each patient. Results: Overall, CI-AKI was observed in 24.7% of patients. Patients with CI-AKI had higher in-hospital death (16.3% vs. 5.1%, p<0.001; relative risk [RR], 2.50; 95% confidence interval [CI], 1.45-4.31) and 1-year post-discharge death (38.1% vs. 17.4%, p<0.001; hazard ratio, 2.16; 95% CI, 1.40-3.34) than those without CI-AKI. Patients with CI-AKI had greater ΔBWTCAG than those without CI-AKI (5.5±5.7% vs. 3.7±4.0%, p<0.001). A J-shaped association between the risk of CI-AKI and ΔBWTCAG was noted. In patients with weight excess (n=179), an increase of ΔBWT by 1% was associated with 9% (RR, 1.09; 95% CI, 1.03-1.16), while in patients with weight deficiency (n=86), a decrease of ΔBWT by 1% was associated with 11% increased risk for CI-AKI (RR, 1.11; 95% CI, 1.05-1.17). Conclusions: In AHF patients undergoing CAG CI-AKI is common and associated with worse clinical outcomes. Achieving optimum body weight before CAG may reduce the risk of CI-AKI. Trial Registration: ClinicalTrials.gov Identifier: NCT01389843.
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