Shrunken pore syndrome prognostic of contrast-induced kidney injury in PCI
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The shrunken pore syndrome phenotype of renal dysfunction after PCI may be a stronger predictor of contrast-induced acute kidney injury compared with chronic kidney disease, researchers reported.
Patients with shrunken pore syndrome, with or without CKD, experienced greater risk for contrast-associated acute kidney injury compared with those without shrunken pore syndrome, according to data published in the Journal of the American Heart Association.
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“Contrast-associated acute kidney injury is the third major pathogenic factor of acute kidney injury and one of the most common complications after percutaneous coronary intervention,” Li-Wei Zhang, MD, of the department of cardiology at Shengli Clinical Medical College of Fujian Medical University in Fuzhou, China, and colleagues wrote. “Early identification of relevant risk factors and appropriate intervention are effective approaches against [contrast-associated acute kidney injury]. Glomerular filtration dysfunction associated with a poor prognosis of [contrast-associated acute kidney injury] is considered as an independent risk factor of that. However, as injury factors are diverse, the changes of glomerular filtration function are extraordinarily complex.
“Shrunken pore syndrome (SPS) is another phenotype of glomerular filtration dysfunction mainly manifested by the impairment of moderate-sized molecular filtration,” Zhang and colleagues wrote. “As [shrunken pore syndrome] is closely related to kidney disease, which is an important risk factor of [contrast-associated acute kidney injury], it is essential to investigate the unknown relationship between [shrunken pore syndrome] and [contrast-associated acute kidney injury].”
Shrunken pore syndrome and contrast-induced kidney injury
For the retrospective analysis, researchers assessed 5,050 adults who underwent elective PCI at the Fujian Provincial Hospital between January 2012 and December 2018.
Serum cystatin C and creatinine were measured and respectively applied to equations to calculate the estimated glomerular filtration rate.
Shrunken pore syndrome was defined as a cystatin C-based eGFR of less than 60% of the creatinine-based eGFR; CKD was defined as creatinine-based eGFR of less than 60 mL per minute per 1.73 m2 without dialysis; and contrast-associated acute kidney injury was defined as an increase in serum creatinine of 50% or more or 0.3 mg/dL within 48 hours after contrast medium exposure.
Overall, 12.85% of patients had shrunken pore syndrome and 6.42% developed contrast-associated acute kidney injury.
After adjusting for potential confounding factors, researchers found that shrunken pore syndrome was associated with contrast-associated acute kidney injury (OR = 4.17; 95% CI, 3.17-5.46; P < .001).
Analysis of receiver operating characteristic showed that cystatin C-based/creatinine-based eGFR ratio was more predictive of contrast-associated acute kidney injury compared with creatinine-based eGFR (area under the curve, 0.707 vs. 0.562; P < .001).
‘A more valuable phenotype of renal dysfunction’
Compared with patients without CKD or shrunken pore syndrome, those with CKD and no shrunken pore syndrome (OR = 1.7; 95% CI, 1.11-2.55; P = .012); those with shrunken pore syndrome without CKD (OR = 4.02; 95% CI, 2.98-5.39; P < .001); and those with concomitant CKD and shrunken pore syndrome (OR = 8.62; 95% CI, 4.67-15.7; P < .001) had increased risk for contrast-associated acute kidney injury.
“To the best of our knowledge, this is the first study revealing the association between [shrunken pore syndrome] and [contrast-associated acute kidney injury] incidence,” the researchers wrote. “Consistent with our hypothesis, the results showed that even after adjusting potential confounding risk factors, [shrunken pore syndrome] was significantly associated with [contrast-associated acute kidney injury] and long-term mortality. Further [receiver operating characteristic] and subgroup analysis revealed that [shrunken pore syndrome] was a more valuable phenotype of renal dysfunction for predicting [contrast-associated acute kidney injury] than CKD.”
In other findings, patients with concomitant shrunken pore syndrome and CKD were at highest risk for long-term mortality compared with patients with neither (HR = 2.3; 95% CI, 1.38-3.86; P = .002).
“Another distinct significance of this study is that we first propose [shrunken pore syndrome] to use in [contrast-associated acute kidney injury] prediction. As a reversible change compared with other risk factors, it is more meaningful because the treatment for [shrunken pore syndrome] before exposure to a contrast medium may reduce the risk of [contrast-associated acute kidney injury],” the researchers wrote. “Glycocalyx can be used as an important therapeutic direction to restore glomerular filtration function. At present, there is no drug to prevent [contrast-associated acute kidney injury]. Therefore, drugs targeting [shrunken pore syndrome] may be a breakthrough for the prevention and treatment of [contrast-associated acute kidney injury] in the future.”
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