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LDL cholesterol as a novel risk factor for contrast-induced acute kidney injury in patients undergoing percutaneous
Yuan-hui Liu1, Yong Liu2, Ji-yan Chen2
1Southern Medical University, Guangzhou 510515, Guangdong, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China.
Insights
High LDL-C levels are an independent risk factor for contrast-induced acute kidney injury (CI-AKI) in patients undergoing PCI. Early identification of high LDL-C may help predict CI-AKI and poor outcomes.
Area of Science:
- Cardiology
- Nephrology
- Biochemistry
Background:
- Low-density lipoprotein cholesterol (LDL-C) is linked to endothelial dysfunction and inflammation, factors in contrast-induced acute kidney injury (CI-AKI).
- The independent role of LDL-C as a risk factor for CI-AKI in patients undergoing percutaneous coronary intervention (PCI) remains unclear.
Purpose of the Study:
- To investigate whether LDL-C is an independent risk factor for CI-AKI in patients undergoing PCI.
- To assess the association between baseline LDL-C levels and CI-AKI development and in-hospital outcomes.
Main Methods:
- Prospective enrollment of 3236 patients undergoing PCI between January 2010 and September 2012.
- Multivariate logistic regression analysis to determine LDL-C as an independent risk factor for CI-AKI.
- CI-AKI defined as an increase in serum creatinine ≥ 0.5 mg/dL or ≥ 25% within 48-72 hours post-contrast.
Main Results:
- CI-AKI occurred in 10.4% of patients, with higher in-hospital mortality (4.4% vs. 0.5%) and complications.
- Higher baseline LDL-C levels were significantly associated with increased risk of CI-AKI (OR=1.23, p=0.014) and composite endpoints.
- LDL-C remained a significant independent risk factor for CI-AKI after adjusting for confounders.
Conclusions:
- Plasma LDL-C concentration is a valuable marker for identifying patients at risk of CI-AKI post-PCI.
- Elevated LDL-C levels are associated with increased risk of CI-AKI and adverse in-hospital outcomes.
- Measurement of LDL-C can aid in risk stratification and management of patients undergoing PCI.
Background:
Low density lipoprotein cholesterol (LDL-C) is associated with endothelial dysfunction, inflammation and increased vasoconstriction, which are involved in the development of contrast-induced acute kidney injury (CI-AKI). However, whether LDL-C is an independent risk factor of CI-AKI in patients undergoing percutaneous coronary intervention (PCI) is unknown.
Methods:
We prospectively enrolled 3236 consecutive patients undergoing PCI between January 2010 and September 2012. Multivariate logistic regression analysis was used to determine whether LDL-C is an independent risk factor of CI-AKI. CI-AKI was defined as an absolute increase in serum creatinine of ≥ 0.5 mg/dL or ≥ 25% over the baseline value within 48-72 h after contrast exposure.
Results:
CI-AKI was observed in 338 patients (10.4%). Patients with CI-AKI had a significantly higher rate of in hospital mortality (4.4% vs. 0.5%, p < 0.001), and significantly higher rates of other in hospital complications compared with those without CI-AKI. The LDL-C quartiles were as follows: Q1 (<2.04 mmol/L), Q2 (2.04-2.61 mmol/L), Q3 (2.61-3.21 mmol/L) and Q4 (>3.21 mmol/L). Patients with high baseline LDL-C levels were more likely to develop CI-AKI and composite end points including all-cause mortality, renal replacement therapy, non-fatal myocardial infarction, acute heart failure, target vessel revascularization or cerebrovascular accident during the observation period of hospitalization (8.9%, 9.9%, 10.5%, 12.6%, p = 0.001, and 5.0%, 5.2%, 6.1%, 8.1%, respectively; p = 0.007). Univariate logistic analysis showed that LDL-C levels (increment 1 mmol/L) were significantly associated with CI-AKI (odds ratio = 1.25, 95% confidence interval (CI), 1.11-1.39, p < 0.001). Furthermore, LDL-C remained a significant risk factor of CI-AKI (odds ratio = 1.23, 95% CI, 1.04-1.45, p = 0.014), even after adjusting for potential confounding risk factors.
Conclusions:
Measurement of plasma LDL-C concentrations in patients undergoing PCI may be helpful to identify those who are at risk of CI-AKI and poor in hospital outcomes.
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