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Acute kidney injury after PCI may confer higher risk for MI, death
Patients who had acute kidney injury after PCI had an elevated risk for MI, death, bleeding and recurrent renal injury after they were discharged, according to a study published in Circulation: Cardiovascular Interventions.
Although acute kidney injury is common after PCI while the patient is in the hospital, there isn’t much information on complications after hospital discharge, according to the study background.
“Understanding this relationship and the timing of these events in a large, multicenter, real-world population may aid clinicians in the identification of critical periods of vulnerability for patients after PCI,” Javier A. Valle, MD, interventional cardiology fellow at the University of Colorado in Aurora, and colleagues wrote.
Researchers analyzed data from 453,475 patients (mean age, 75 years, 42% women) who underwent PCI between November 2004 and December 2009. Acute kidney injury and its severity were categorized into three stages: no acute kidney injury, acute kidney injury stage 1 ( 0.3 mg/dL absolute or 1.5- to twofold increase in serum creatinine) and acute kidney injury stage 2/3 (> two- or threefold increase in serum creatinine; > 4 mg/dL with a sharp increase of 0.5 mg/dL). Stages 2 and 3 were combined to provide a sufficient cohort size.
The primary outcome was a composite of MI, death and hospitalization as a result of bleeding within 1 year of discharge from PCI. Secondary endpoints were defined as individual events of MI, death or hospitalization from bleeding, as well as post-discharge hospitalization for acute kidney injury including cases that require dialysis.
Effects of acute kidney injuryOf the patients in the study cohort, 8.8% (n = 39,850) were diagnosed with acute kidney injury while in the hospital after PCI. Most cases were stage 1 severity (7.5%), and 1.2% were stage 2/3 severity. Within 1 year of discharge, patients with stage 2/3 severity of acute kidney injury experienced more cases of the primary outcome (34.1%) compared with those with stage 1 (24%) or no acute kidney injury (11.1%; P < .001). Regardless of injury severity, patients mostly experienced adverse events within 30 days after discharge from the hospital.
Researchers noted that after covariate adjustment, patients with acute kidney injury in the hospital had a higher risk for the primary outcome vs. those with no acute kidney injury. The risk increased with the severity of acute kidney injury (HR for stage 1 = 1.53; 95% CI, 1.49–1.56; HR for stage 2/3 = 2.13; 95% CI, 2.01–2.26).
Patients who developed in-hospital acute kidney injury were at elevated risk for re-hospitalization for their stage 1 (HR = 1.7; 95% CI, 1.64–1.76) or stage 2/3 injury (HR = 2.22; 95% CI, 2.04–2.41) once they were discharged. The risk for acute kidney injury requiring dialysis was also elevated in patients with stage 1 (HR = 2.59; 95% CI, 2.29–2.92) and stage 2/3 severity (HR = 4.73; 95% CI, 3.73–5.99).
“Clinicians should be aware of an increased risk of adverse events after hospital discharge among patients having post-PCI [acute kidney injury], including recurrent renal injury,” Valle and colleagues wrote. – by Darlene Dobkowski
Disclosure: The researchers report no relevant financial disclosures.