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Persistent Renal Dysfunction After Acute Kidney Injury Among STEMI Patients Undergoing Primary Coronary Intervention:
Shir Frydman1, Ophir Freund1, Haytham Abu Katash1
1Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
Acute kidney disease (AKD) is common in ST-elevation myocardial infarction (STEMI) patients with acute kidney injury (AKI). Early monitoring for AKD in STEMI patients with chronic kidney disease (CKD) is crucial for preventing renal deterioration.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Acute kidney injury (AKI) is a significant complication of ST-elevation myocardial infarction (STEMI).
- Acute kidney disease (AKD) describes prolonged renal injury (7-90 days), bridging the gap between AKI and chronic kidney disease (CKD).
- Understanding AKD prevalence and predictors in STEMI is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the prevalence of AKD in patients with STEMI and AKI.
- To identify predictors of AKD development in STEMI patients.
- To assess the impact of AKD on mortality in STEMI patients.
Main Methods:
- Retrospective observational study of 2940 STEMI patients (2008-2022).
- Renal function assessed at admission and routinely thereafter.
- AKD defined as persistent renal injury (7-90 days) per KDIGO criteria.
Main Results:
- 46% of STEMI patients with AKI developed AKD (117/252).
- Higher AKD rates observed in patients with baseline CKD (60% vs. 46%).
- AKD independently predicted higher 1-year mortality, especially in patients with CKD.
Conclusions:
- AKD is a frequent outcome in STEMI patients experiencing AKI.
- CKD and higher KDIGO stage are critical factors for AKD development and prognosis.
- Strict monitoring is recommended for early diagnosis and management of AKD in at-risk STEMI patients.
Background:
Acute kidney injury (AKI) is a common and serious complication of ST-elevation myocardial infarction (STEMI). AKI and chronic kidney disease (CKD) are highly heterogeneous, leaving a wide gap between them. Therefore, the term acute kidney disease (AKD) was implemented, describing prolonged renal injury between 7 and 90 days. We aimed to evaluate the prevalence and predictors of AKD among STEMI patients.
Methods:
This retrospective observational study included 2940 consecutive patients admitted with STEMI between 2008 and 2022. Renal function was assessed upon admission and routinely thereafter. Renal outcomes were evaluated according to KDIGO criteria, with AKD defined as persistent renal injury of between 7 and 90 days.
Results:
Two hundred and fifty-two subjects with STEMI and AKI were included; of them, 117 (46%) developed AKD. Among baseline CKD patients, higher rates of AKD were observed (60% vs. 46%). KDIGO index ≥ 2 was an independent predictor for AKD in in subjects without baseline CKD (AOR 2.63, 95% CI 1.07-6.53). In subjects with baseline CKD, older age and higher creatinine were independent predictors for AKD. Subjects with AKD had a higher 1-year mortality rate (HR 3.39, 95% CI 1.71-6.72, p < 0.01). This trend was mainly driven by the CKD subpopulation where higher mortality rates for AKD on CKD were observed (HR 5.26, 95% CI 1.83-15.1, p < 0.01).
Conclusion:
AKD is common among STEMI patients with AKI. The presence of CKD and higher KDIGO stage should prompt strict monitoring for early diagnosis, treatment, and prevention of renal function deterioration.
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