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Renalism: an obstacle to left heart catheterization in chronic kidney disease patients

Ahmad Mustafa1, Alaukika Agarwal2, Chapman Wei2

  • 1Department of Cardiology, Staten Island University Hospital, Staten Island, NY, United States.

Journal of Nephrology
|June 16, 2026
PubMed

Insights

Patients with chronic kidney disease (CKD) undergoing left heart catheterization for non-ST-elevation myocardial infarction (NSTEMI) had lower mortality and better outcomes. Despite risks, this procedure is associated with improved survival in CKD patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Health Services Research

Background:

  • Therapeutic nihilism in kidney disease, termed "renalism," delays interventions for patients with chronic kidney disease (CKD).
  • Clinicians exhibit reluctance in performing contrast-based procedures, like left heart catheterization, for individuals with CKD.
  • Non-ST-elevation myocardial infarction (NSTEMI) often necessitates left heart catheterization, and delays in this procedure can escalate mortality and adverse cardiovascular events.

Purpose of the Study:

  • To investigate the association between left heart catheterization and outcomes in patients with NSTEMI and CKD.
  • To address the impact of "renalism" and contrast-associated acute kidney injury (CA-AKI) concerns on clinical practice for CKD patients undergoing NSTEMI treatment.

Main Methods:

  • Utilized the National Inpatient Sample Database (2016-2018) for NSTEMI patients.
  • Excluded patients under 18, with missing data, or kidney failure; stratified remaining patients into CKD 1-2 and CKD 3-5 groups.
  • Performed 1:1 propensity score matching to compare mortality and cardiovascular outcomes between CKD 3-5 patients who underwent left heart catheterization and those who did not.

Main Results:

  • CKD 3-5 patients were less likely to undergo left heart catheterization, experiencing increased mortality.
  • After propensity score matching, CKD 3-5 remained independently associated with fewer left heart catheterizations.
  • Left heart catheterization in CKD 3-5 patients was linked to a 1.93-fold decrease in in-hospital mortality, improved cardiovascular outcomes, and reduced acute kidney injury (AKI) (P < .001).

Conclusions:

  • Practice guideline alterations driven by CA-AKI risks reduce left heart catheterization rates in CKD patients, leading to higher mortality and adverse cardiovascular outcomes.
  • The findings suggest that the benefits of left heart catheterization in CKD patients with NSTEMI may outweigh the risks.
  • Further research is essential to comprehensively evaluate the risk-benefit profile of contrast-based interventions in this vulnerable patient population.
Abstract

Keywords:
NSTEMIchronic kidney diseasecontrast-associated acute kidney injuryleft heart catheterization

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