A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study

Lun, Zhubin; Li, Lei; Zhou, Dianhua; Ying, Ming; Liu, Liwei; Chen, Guanzhong; He, Yibo; Li, Huanqiang; Huang, Zhidong; Yang, Yongquan; Ye, Jianfeng; Liu, Yong

doi:10.1186/s12872-020-01778-6

Cited by 7 publications

(14 citation statements)

References 31 publications

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“…For example, Centola et al investigated 402 ST-segment elevation MI (STEMI) patients who underwent primary PCI and detected a remarkable correlation between mortality and CA-AKI when applying the ESUR and AKIN definitions during a median 1-year followup period (27); in addition, the AKIN classification achieved better prognostic accuracy than the ESUR criteria (area under the receiver operating curve; 0.7984 vs. 0.7759; p = 0.0331). Similarly, Lun et al showed that both the ESUR and AKIN definitions were associated with long-term mortality (28). However, it is noteworthy that the population attributable risk (PAR) for the AKIN definition was greater, thus indicating that this definition exhibited higher clinical relevance than the ESUR definition.…”

Section: Discussionmentioning

confidence: 97%

A Comparison Between Two Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Elderly and Non-elderly Patients After Elective Percutaneous Coronary Intervention

You

Lin

et al. 2021

Front. Cardiovasc. Med.

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Background: Contrast-associated acute kidney injury (CA-AKI) is responsible for a substantial proportion of the observed mortality that occurs after percutaneous coronary intervention (PCI), particularly in elderly patients. However, there has been significant and debate over whether the optimal definition of CA-AKI persists over prolonged periods due to variations in the prevalence and effects on prognosis. In this study, we aimed to identify whether different definitions of CA-AKI exert differential impacts on long-term mortality when compared between elderly and non-elderly patients receiving elective PCI.Methods: We prospectively investigated 5,587 consenting patients undergoing elective PCI between January 2012 and December 2018. We considered two classical definitions of CA-AKI from the European Society of Urogenital Radiology (ESUR) and the Acute Kidney Injury Network (AKIN). Multivariable Cox regression analysis was used to investigate the association between CA-AKI and long-term mortality. We also performed interaction and stratified analyses according to age (≤75 or >75 years).Results: The incidence of CA-AKI according to the ESUR and AKIN definitions was 18.7 and 6.1%, respectively. After a median follow-up of 2.1 years, multivariable Cox regression analysis indicated that CA-AKI according to the AKIN definition was a risk factor for long-term mortality in the overall population [hazard ratio (HR) = 2.20; 95% confidential interval (CI): 1.51–3.22; p < 0.001]; however, this was not the case for the ESUR definition (HR = 1.27; 95% CI: 0.92–1.76; p = 0.153). Further interaction analysis identified a significant interaction between age and the ESUR definition (p = 0.040). Stratified analyses also found an association between the ESUR definition and long-term mortality in patients >75 years of age (p = 0.011), but not in patients ≤75 years of age (p = 0.657).Conclusion: As a stringent definition of CA-AKI, the AKIN definition was significantly associated with long-term mortality in both non-elderly and elderly patients. However, in elderly patients, the more lenient definition provided by the ESUR was also significantly correlated with long-term mortality, which could sensitively identify high-risk elderly patients and may provide a better alternative.

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Section: Discussionmentioning

confidence: 97%

A Comparison Between Two Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Elderly and Non-elderly Patients After Elective Percutaneous Coronary Intervention

You

Lin

et al. 2021

Front. Cardiovasc. Med.

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“…The traditional scoring system using the NCDR-AKI risk model is an effective in estimating the risk of AKI after PCI 9 , 10 . We used the definition of AKI as serum creatinine by ≥ 0.3 mg/dl or an increase to ≥ 50% since this definition is the most optimal to predict short-term and long-term adverse mortality as well as the NCDR-AKI risk model 9 , 12 , 30 , 31 . Additionally, we did not include contrast volume according to the NCDR-AKI risk model because the causes of AKI are multifactorial such as contrast or hemodynamically instability and pre-operative assessment the risk of AKI is paramount to decrease the amount of contrast volume.…”

Section: Discussionmentioning

confidence: 99%

Machine learning prediction model of acute kidney injury after percutaneous coronary intervention

Kuno

Mikami

Sahashi

et al. 2022

Sci Rep

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Acute kidney injury (AKI) after percutaneous coronary intervention (PCI) is associated with a significant risk of morbidity and mortality. The traditional risk model provided by the National Cardiovascular Data Registry (NCDR) is useful for predicting the preprocedural risk of AKI, although the scoring system requires a number of clinical contents. We sought to examine whether machine learning (ML) techniques could predict AKI with fewer NCDR-AKI risk model variables within a comparable PCI database in Japan. We evaluated 19,222 consecutive patients undergoing PCI between 2008 and 2019 in a Japanese multicenter registry. AKI was defined as an absolute or a relative increase in serum creatinine of 0.3 mg/dL or 50%. The data were split into training (N = 16,644; 2008–2017) and testing datasets (N = 2578; 2017–2019). The area under the curve (AUC) was calculated using the light gradient boosting model (GBM) with selected variables by Lasso and SHapley Additive exPlanations (SHAP) methods among 12 traditional variables, excluding the use of an intra-aortic balloon pump, since its use was considered operator-dependent. The incidence of AKI was 9.4% in the cohort. Lasso and SHAP methods demonstrated that seven variables (age, eGFR, preprocedural hemoglobin, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction/unstable angina, heart failure symptoms, and cardiogenic shock) were pertinent. AUC calculated by the light GBM with seven variables had a performance similar to that of the conventional logistic regression prediction model that included 12 variables (light GBM, AUC [training/testing datasets]: 0.779/0.772; logistic regression, AUC [training/testing datasets]: 0.797/0.755). The AKI risk model after PCI using ML enabled adequate risk quantification with fewer variables. ML techniques may aid in enhancing the international use of validated risk models.

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“…13 Compared to the 28% rate of CA-AKI among patients with DM in the present study, another recent study found a rate of 37% in patients with DM undergoing percutaneous coronary interventions (PCI) using the same definition of CA-AKI as in the present study, but the amount of iodinated contrast media administered was not stated. 14 There might be several reasons for the lower doses of administered iodine contrast media in patients with DM than those without DM during thrombolysis. The occlusive lesions may be more distal in patients with DM, even if this could not be convincingly shown in the present study, necessitating less accurate angiographic imaging of the aorto-iliac segment and therefore less need of contrast media.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Contrast-Associated Acute Kidney Injury in Patients with and without Diabetes Mellitus Undergoing Computed Tomography Angiography and Local Thrombolysis for Acute Lower Limb Ischemia

Butt

Lehti

Apelqvist

et al. 2021

Vasc Endovascular Surg

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Purpose Repetitive iodinated contrast media exposure may be harmful for the kidneys. The aim of the present study was to evaluate if patients with diabetes mellitus (DM) undergoing CT angiography (CTA) and local continuous thrombolysis for acute lower limb ischemia (ALI) had an increased risk of developing contrast-associated acute kidney injury (CA-AKI) compared to patients without DM. Methods: This is a retrospective study of patients undergoing CTA and local continuous thrombolysis due to ALI between 2001 and 2018. CA-AKI was defined as a 25% increase in serum creatinine within 72 hours after latest contrast administration. Results: There was no difference ( P = .30) in the frequency of CA-AKI between patients with (27.9%; n = 43) and without DM (20.6%; n = 170). Among patients with CA-AKI, patients with DM had a lower ( P < .001) estimated glomerular filtration rate (eGFR) at discharge (55 ml/min/1.73 m2) than at admission (70 ml/min/1.73 m2), while no such difference was found in the group without DM ( P = .20). The gram-iodine dose/eGFR ratio was higher ( P < .001) in patients with CA-AKI (median 1.49, [IQR 1.34-1.81]) than in those who did not develop CA-AKI (median 1.05 [IQR 1.00-1.13]). There was a trend that gram-iodine dose/eGFR ratio (OR 1.42/standard deviation increment, 95% CI 1.00-2.02; P = .050) was associated with an increased risk of CA-AKI, after adjusting for DM, age, and gender. Conclusions: The frequency of CA-AKI was high after CTA and local continuous thrombolysis for ALI without shown increased frequency for the DM group. Among patients with CA-AKI, however, patients with DM had worse renal function at discharge than those without DM. The gram-iodine dose/eGFR ratio in these patients needs to be lower to improve renal outcomes, particularly in patients with DM.

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A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study

Cited by 7 publications

References 31 publications

A Comparison Between Two Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Elderly and Non-elderly Patients After Elective Percutaneous Coronary Intervention

A Comparison Between Two Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Elderly and Non-elderly Patients After Elective Percutaneous Coronary Intervention

Machine learning prediction model of acute kidney injury after percutaneous coronary intervention

Contrast-Associated Acute Kidney Injury in Patients with and without Diabetes Mellitus Undergoing Computed Tomography Angiography and Local Thrombolysis for Acute Lower Limb Ischemia

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