https://orcid.org/0009-0005-9812-8014
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Abstract
Background
Contrast-associated acute kidney injury (CA-AKI) is a prevalent complication following coronary angiography (CAG). However, there is ongoing controversy surrounding its precise definition. Although previous studies have demonstrated the successful application of appropriate definitions in managing high-risk CA-AKI patients, there remains limited research on the association between different definitions and prognosis specifically in patients with chronic kidney disease (CKD).
Methods
A total of 4197 CKD patients undergoing coronary angiography (CAG) were included in this study. Two definitions of contrast-associated acute kidney injury (CA-AKI) were used: CA-AKIA, which was defined as an increase of ≥0.5 mg/dL or >25% in serum creatinine (SCr) from baseline within 72 hours after CAG, and CA-AKIB, which was defined as an increase of ≥0.3 mg/dL or >50% in SCr from baseline within 48 hours after CAG. Cox regression analysis was employed to assess the association between these two definitions and long-term mortality. Additionally, population attributable risks (PARs) were calculated to evaluate the impact of CA-AKI definitions on long-term prognosis.
Results
During the median follow-up period of 4.70 (2.50–7.78) years, the overall long-term mortality was 23.6%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 33.5% and 33.8%, respectively. We found that CA-AKIA (HR: 1.45, 95% CI: 1.23–1.70, p<0.001) and CA-AKIB (HR: 1.44, 95% CI: 1.23–1.69, p<0.001) were associated with long-term mortality. The PARs were the highest for CA-AKIA (5.87%), followed by CA-AKIB (5.70%).
Conclusion
Contrast-associated acute kidney injury (CA-AKI) is a frequently observed complication in CKD patients undergoing coronary angiography (CAG), and both definitions of CA-AKI are significantly correlated with a poor long-term prognosis. Consequently, in the clinical management of CKD patients, it is crucial to prioritize CA-AKI, irrespective of the specific CA-AKI definition used.
Abbreviations
CA-AKI, Contrast-associated acute kidney injury; CAG, Complication following coronary angiography; CKD, Chronic kidney disease; AKIN, Acute Kidney Injury Network; PARs, Population attributable risks; eGFR, Estimated glomerular filtration rate; PCI, Percutaneous coronary intervention; MDRD, Modification of Diet in Renal Disease; CHF, Chronic heart failure; NYHA, New York Heart Association.
Data Sharing Statement
The dataset generated for this study is not publicly available, but is available from the corresponding author upon reasonable request.
Ethics Approval and Consent to Participate
The studies involving human participants were reviewed and approved by The Ethics Committee of Dongguan Traditional Chinese Medicine Hospital (approval number: PJ (2023) 31). Prior to the study, all participants had given informed consent and signed written informed consent.
Consent for Publication
All authors have given consent for publication.
Acknowledgments
We thank all subjects and colleagues for participating in the study.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors declare that they have no competing interests in this work.