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Comparison Between Two Definitions of Contrast-Associated Acute Kidney Injury in Patients With Congestive Heart
Bo Wang1,2, Yiying Zheng3,4, Huanqiang Li1,2
1Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
Contrast-associated acute kidney injury (CA-AKI) increases long-term mortality risk in congestive heart failure (CHF) patients. The CA-AKIA definition better predicts this risk, highlighting its importance for cardiologists.
Area of Science:
- Nephrology
- Cardiology
- Clinical Research
Background:
- Contrast-associated acute kidney injury (CA-AKI) is a significant concern in patients with congestive heart failure (CHF).
- Existing definitions of CA-AKI vary, impacting their prognostic value.
- The long-term prognostic implications of different CA-AKI definitions in CHF patients remain under-explored.
Purpose of the Study:
- To evaluate the association between different CA-AKI definitions and long-term mortality in CHF patients.
- To compare the population attributable risks (PAR) of various CA-AKI definitions for predicting long-term prognosis.
Main Methods:
- A cohort of 2,207 CHF patients undergoing coronary angiography was studied.
- Two CA-AKI definitions were applied: CA-AKIA (≥0.5 mg/dl or >25% SCr increase within 72h) and CA-AKIB (≥0.3 mg/dl or >50% SCr increase within 48h).
- Kaplan-Meier analysis and Cox regression assessed long-term mortality; PAR was calculated.
Main Results:
- Over a median 3.8-year follow-up, overall mortality was 24.9%.
- Both CA-AKIA (HR 1.44) and CA-AKIB (HR 1.48) were linked to increased long-term mortality.
- CA-AKIA demonstrated a higher population attributable risk (9.6%) compared to CA-AKIB (8%).
Conclusions:
- CA-AKI is associated with long-term mortality in CHF patients, regardless of the definition used.
- The CA-AKIA definition is superior for predicting long-term prognosis in this population due to its higher PAR.
- Cardiologists should closely monitor for CA-AKI, particularly using the CA-AKIA criteria, in CHF patients.
Background:
Different definitions of contrast-associated acute kidney injury (CA-AKI) have different predictive effects on prognosis. However, few studies explored the relationship between these definitions and long-term prognosis in patients with congestive heart failure (CHF). Thus, we aimed to evaluate this association and compared the population attributable risks (PAR) of different CA-AKI definitions.
Methods:
This study enrolled 2,207 consecutive patients with CHF undergoing coronary angiography (CAG) in Guangdong Provincial People's Hospital. Two different definitions of CA-AKI were used: CA-AKIA was defined as an increase ≥.5 mg/dl or > 25% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIB was defined as an increase of ≥.3 mg/dl or > 50% in SCr from baseline within 48 h after CAG. Kaplan-Meier methods and Cox regression were applied to evaluate the association between CA-AKI with long-term mortality. Population attributable risk (PAR) of different definitions for long-term prognosis was also calculated.
Results:
During the 3.8-year median follow-up (interquartile range 2.1-6), the overall long-term mortality was 24.9%, and the long-term mortality in patients with the definitions of CA-AKIA and CA-AKIB were 30.4% and 34.3%, respectively. We found that CA-AKIA (HR: 1.44, 95% CI 1.19-1.74) and CA-AKIB (HR: 1.48, 95% CI 1.21-1.80) were associated with long-term mortality. The PAR was higher for CA-AKIA (9.6% vs. 8%).
Conclusions:
Our findings suggested that CA-AKI was associated with long-term mortality in patients with CHF irrespective of its definitions. The CA-AKIA was a much better definition of CA-AKI in patients with CHF due to its higher PAR. For these patients, cardiologists should pay more attention to the presence of CA-AKI, especially CA-AKIA.
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