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Acute kidney injury following coronary revascularization procedures in patients with advanced CKD

Abduzhappar Gaipov1,2, Miklos Z Molnar3,4,5, Praveen K Potukuchi1

  • 1Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|July 10, 2018
PubMed

Insights

Coronary artery bypass grafting (CABG) significantly increases the risk of acute kidney injury (AKI) in patients with advanced chronic kidney disease (CKD) compared to percutaneous coronary interventions (PCI). This finding is crucial for revascularization strategy decisions in this high-risk group.

Area of Science:

  • Nephrology
  • Cardiology
  • Cardiovascular Surgery

Background:

  • Previous studies suggest Coronary Artery Bypass Grafting (CABG) offers better outcomes than Percutaneous Coronary Interventions (PCI) for mild to moderate Chronic Kidney Disease (CKD).
  • Limited data exists on the comparative outcomes of CABG versus PCI in patients with advanced stages of CKD.
  • Acute Kidney Injury (AKI) is a significant concern in patients with advanced CKD undergoing cardiac procedures.

Purpose of the Study:

  • To evaluate the incidence and relative risk of AKI after CABG compared to PCI in patients with advanced CKD.
  • To inform clinical decision-making regarding revascularization strategies for this vulnerable patient population.

Main Methods:

  • A cohort of 730 US veterans with incident End-Stage Renal Disease (ESRD) who underwent either CABG or PCI were analyzed.
  • The study examined outcomes up to 5 years prior to dialysis initiation.
  • Multivariable adjusted logistic regression analyses were used to assess the association between CABG and PCI with AKI.

Main Results:

  • The incidence of AKI was substantially higher after CABG (67%) compared to PCI (31%) (P < 0.001).
  • CABG was associated with a 4.5-fold higher crude risk of AKI (OR 4.53; 95% CI 3.28-6.27), which remained significant after multivariable adjustments (OR 3.50; 95% CI 2.03-6.02).
  • All stages of AKI were more frequent following CABG than PCI.

Conclusions:

  • Coronary Artery Bypass Grafting (CABG) is linked to a significantly higher risk of Acute Kidney Injury (AKI) in patients with advanced Chronic Kidney Disease (CKD) when compared to Percutaneous Coronary Interventions (PCI).
  • The elevated risk of AKI associated with CABG necessitates careful consideration in this patient group when selecting the optimal revascularization strategy.
  • While CABG may offer other benefits, the heightened risk of AKI is a critical factor for clinicians and patients to weigh.
Abstract

Keywords:
acute kidney injurychronic kidney diseasecoronary artery bypass graftingpercutaneous coronary interventions

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