Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

Abstract

BackgroundIn acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.Methods and ResultsAt admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)−46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA−C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA−C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55–0.69]; P=0.001) and ΔA−C (area under the curve: 0.62 [95% confidence interval, 0.54–0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA−C to acute glycemia allowed proper AKI risk prediction in 16% of patients.ConclusionsIn diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.

High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational Study

“…At the same time, the risk of AKI increased in parallel with admission hs-CRP values, while a significant relationship between hs-CRP value and maximal sCr increase was observed in the entire study population. Remarkably, risk prediction accuracy improved after the addition of hs-CRP to admission sCr, the most common predictor of AKI in AMI studies, as well as in studies performed in other clinical settings [32][33][34]. The accuracy of AKI prediction also improved when hs-CRP was added to a clinical model including other well-known independent predictors of AKI in AMI (age, LVEF, sCr, admission glycemia, and AMI type) [33], allowing a reclassification of AKI risk in nearly 10% of patients.…”

Predictive value of stress hyperglycemia ratio for the occurrence of acute kidney injury in acute myocardial infarction patients with diabetes

“…However, the association between elevated glycemia at admission and risk of AKI was more prominent in non-DM patients than in DM after AMI [ 28 ]. Several studies proved that admission glycemia (ABG) could predict AKI and CV events in non-DM [ 29 , 30 ], but it was no longer a significant predictor of prognosis in DM [ 9 , 10 ]. Similarly, we found that elevated ABG was not a risk factor for AKI and CV events in AMI patients with DM.…”

“…Elevated glycemia at admission has been used to identify stress hyperglycemia, however, its values are affected by both acute stress condition and chronic glycemic control, and a high value of admission blood glucose (ABG) doesn’t necessarily indicate an acute glucose-level rise in response to AMI, especially in DM patients with chronic glycemic elevation [ 8 ]. Previous studies also proved that the relationship between admission glycemia and the risk of AKI was prominent among nondiabetic patients, however, it was no longer significant in patients with DM [ 9 , 10 ]. These findings suggest that a relative increase in glycemia may have more clinical implications in early recognition and prevention of AKI in AMI patients with DM.…”

Renin-angiotensin-aldosterone system blockade is associated with higher risk of contrast-induced acute kidney injury in patients with diabetes

“…Experimental and clinical evidence has shown that acutely increased plasma glucose levels suppress flow-mediated vasodilatation and promote vascular damage through increased production of oxygen-derived free radicals [32,33]. Moreover, acute hyperglycemia may induce osmotic diuresis, resulting in volume depletion and dehydration and further increasing AKI risk and severity [34]. Therefore, conditions associated with hyperglycemia, like diabetes, may exacerbate through oxidative stress the deleterious effects of contrast agents on kidney function and thus increase CIAKI risk.…”