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Acute kidney injury worsens CV, renal outcomes in MI
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Patients with MI who develop acute kidney injury are at increased risk for major adverse cardiac and renal events than those with kidney injury or MI alone, according to recent study findings.
The researchers evaluated data from 36,980 patients enrolled in the Veterans Affairs database. All of the patients were diagnosed with acute kidney injury or MI between October 1999 and December 2005, and were grouped according to whether they were diagnosed with acute kidney injury (n=8,426), MI (n=18,921) or both (n=9,633). Incidence of mortality and major adverse kidney and cardiac events was compared between the three groups during a maximum of 6 years of follow-up.
The most deaths occurred in the group with both MI and acute kidney injury (57.5% of patients), whereas the group with uncomplicated MI experienced the lowest mortality rate (32.3%). Patients with acute kidney injury alone or both injury and MI had significantly increased risk for major adverse renocardiovascular events than those with MI alone, after adjustment for confounders (adjusted HR=1.37; 95% CI, 1.32-1.42 for kidney injury alone and HR=1.92; 95% CI, 1.86-1.99 for MI and injury).
Using a regression model for time from admission to death, risk was higher among patients with both acute kidney injury alone (HR=1.85; 95% CI, 1.76-1.94) and both MI and kidney injury (HR=2.14; 95% CI, 2.05-2.23) than with those with MI alone. A model predicting time to major cardiac events yielded an HR of 0.4 (95% CI, 0.38-0.44) for the kidney injury group and 1.24 (95% CI, 1.18-1.3) for the MI/injury group compared with MI alone, whereas risk for major kidney events was significantly higher in the kidney injury (HR=2.07; 95% CI, 1.99-2.16) and MI/injury groups (HR=2.3; 95% CI, 2.21-2.38).
Sensitivity analyses excluding patients with STEMI yielded similar results, as did stratification according to estimated glomerular filtration rate tertile and the lowest rate observed during admission. Stratification according to severity of kidney injury indicated increased incidence of mortality and both major kidney and cardiac events with increasing severity in the MI/kidney injury group.
“The findings from this study will be critical for planning future interventional trials in patients with acute kidney injury,” Lakhmir Chawla, MD, of George Washington University and Veteran Affairs Medical Center, said in a press release. “Because acute kidney injury remains an ongoing and increasing public health hazard, more research into the treatment and management of this syndrome is critically required.”
Disclosure: The researchers report no relevant financial disclosures.
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