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Nomogram for contrast-induced acute kidney injury in patients with chronic kidney disease undergoing coronary angiography in China: a cohort study.

ABSTRACT: OBJECTIVES:To establish a nomogram for contrast-induced acute kidney injury (CI-AKI) risk assessment among patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). DESIGN:Prospective observational cohort study. SETTING:Southern China. INTERVENTIONS:None. PARTICIPANTS:643 consecutive patients with CKD (defined as estimated glomerular filtration rate calculated by Modification of Diet in Renal Disease formula <60?mL/min/1.73?mm2) were enrolled. OUTCOME MEASURES:The end point was CI-AKI defined as serum creatinine elevation ?0.5?mg/dL or 25% from baseline within the first 48-72?hours following contrast exposure.Predictors of CI-AKI were selected by multivariable logistic regression and stepwise approach. A nomogram based on these predictors was constructed and compared with the classic Mehran Score. For validation, a bootstrap method (1000 times) was performed. RESULTS:The nomogram including age, weight, heart rate, hypotension, PCI and ?-blocker demonstrated a better predictive value than the classic Mehran Score (area under the curve: 0.78 vs 0.71, p=0.024), as well as a well-fitted calibration curve (?2=12.146, p=0.145). Validation through the bootstrap method (1000 times) also indicated a good discriminative power (adjusted C-statistic: 0.76). CONCLUSIONS:With fewer predictors and higher discriminative power, the present nomogram may be a simple and reliable tool to identify patients with CKD at risk of CI-AKI, whereas further external validations are needed.

SUBMITTER: Lei L

PROVIDER: S-EPMC7259871 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Nomogram for contrast-induced acute kidney injury in patients with chronic kidney disease undergoing coronary angiography in China: a cohort study.

Lei Li L Xue Yan Y Guo Zhaodong Z Liu Bowen B He Yibo Y Liu Jin J Nie Zhiqiang Z Chen Liling L Chen Kaihong K Huang Zhidong Z Liang Min M Chen Shiqun S Liu Yong Y Chen Jiyan J

BMJ open 20200526 5

<h4>Objectives</h4>To establish a nomogram for contrast-induced acute kidney injury (CI-AKI) risk assessment among patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).<h4>Design</h4>Prospective observational cohort study.<h4>Setting</h4>Southern China.<h4>Interventions</h4>None.<h4>Participants</h4>643 consecutive patients with CKD (defined as estimated glomerular filtration rate calculated by Modification of Diet in Renal ...[more]

PMID: 32461299

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Project description:BackgroundPrevious studies have shown that renal function recovery after acute kidney injury (AKI) was associated with decreased risk of all-cause mortality. However, little is known about the correlation between renal function recovery and long-term prognosis in patients with contrast-associated acute kidney injury (CA-AKI) undergoing coronary angiography (CAG).MethodsWe retrospectively enrolled 5,865 patients who underwent CAG. CA-AKI was defined as an increase in serum creatinine (SCr) ≥ 50% or ≥ 0.3 mg/dl from baseline within 72 h post procedure. Recovered CA-AKI was defined as a decrease in SCr to baseline or no CA-AKI level. The first endpoint was long-term all-cause mortality. Kaplan-Meier analysis and Cox regression analysis were used to investigate the association between kidney function recovery and long-term mortality.ResultsDuring the median follow-up period of 5.25 years, the overall long-term mortality was 20.07%, and the long-term mortality in patients with recovered CA-AKI and non-recovered CA-AKI was 17.46 and 27.44%, respectively. After multivariate Cox hazard regression, non-recovered CA-AKI was significantly associated with long-term mortality, while recovered CA-AKI was not [recovered CA-AKI vs. no CA-AKI, hazard ratio (HR) = 1.06, 95% confidence interval (CI): 0.81-1.39, p = 0.661; non-recovered CA-AKI vs. no CA-AKI, HR = 1.39, 95% CI: 1.21-1.60, p < 0.001]. In the subgroup of CAD, both recovered CA-AKI and non-recovered CA-AKI were associated with increased risk of long-term all-cause mortality. However, in other subgroup analyses, only non-recovered CA-AKI was associated with increased risk of long-term all-cause mortality.ConclusionOur results found that non-recovered CA-AKI is significantly associated with long-term mortality. In patients with CAD, recovered CA-AKI can still increase the risk of all-cause mortality. Clinicians need to pay more attention to patients suffering from CA-AKI, whose kidney function has not recovered. In addition, active prevention treatments should be taken by patients with CAD.

Dataset Information

Nomogram for contrast-induced acute kidney injury in patients with chronic kidney disease undergoing coronary angiography in China: a cohort study.

Publications

Nomogram for contrast-induced acute kidney injury in patients with chronic kidney disease undergoing coronary angiography in China: a cohort study.

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