Impact of acute kidney injury in elderly (≥80 years) patients undergoing percutaneous coronary intervention

Abstract

AKI occurs in a third of elderly (≥80 years) patients undergoing PCI and is associated with increased mortality. These findings underline the unmet clinical need to identify novel strategies for the prevention of AKI in this high-risk patient subset.

Prognostic significance of malnutrition scores in elderly patients for the prediction of contrast‐induced acute kidney injury

“…CI-AKI is seen in 8%-20% of younger populations and 21%-27% of the elderly populations after diagnostic or interventional cardiac procedures. 2, [35][36][37] Some studies show that low albumin levels, neutrophillymphocyte ratio, inflammatory markers such as CRP are associated with CI-AKI; in addition, the presence of inflammation, which is evaluated individually with these parameters, is predictive for CI-AKI. 20 The increased inflammatory response and malnutrition are common in CAD.…”

“…Despite the pre‐procedure premedication or avoidance protocols applied during the procedure, CI‐AKI can be seen at considerable rates. CI‐AKI is seen in 8%‐20% of younger populations and 21%‐27% of the elderly populations after diagnostic or interventional cardiac procedures 2,35‐37 …”

Acute Kidney Injury and Long-Term Risk for Cardiovascular Events in Patients after Kidney Transplantation

“…This association was extensively studied in other populations: patients that developed AKI during hospitalization [13], patients after acute coronary syndrome [14] and percutaneous coronary interventions or bypass grafting [15,16], tricuspid annuloplasty [17] or patients after non-cardiac operation [18,19] with conflicting results [13]. In a recent metaanalysis that included 25 studies involving 254,408 adults [12], AKI was associated with an 86% increased risk of CV mortality and a 38% increased risk of MACEs.…”

Acute kidey injury risks during cardiac operations are too numerous to count? Could a single actionable variable be the answer?

“…Mannitol not considered an evidence-based intervention to limit AKI 10 Corticosteroid treatment in neonates undergoing cardiac surgery did not reduce AKI 11 N-acetylcysteine not helpful to reduce AKI (meta-analysis) 12 Allogeneic mesenchymal stem cells 13 Things with uncertain or conflicting evidence but being studied Dexmedetomidine and acetaminophen [14][15][16] Slidenafil for AKI (randomized controlled trial) 17 Intra-aortic balloon 18 Vascular endothelial integrity 19 Remote ischemic preconditioning 20,21 Dexmedetomidine and acetaminophen [14][15][16] Things that may worsen AKI risk during cardiac procedures Perioperative statin therapy (but not preoperative only therapy) increases AKI risk 22 Fibrinogen prophylaxis during heart transplant 23 Advanced age 80 y 24 Severe bleeding 25 https://doi.org/10.1016/j.jtcvs.2019.06.012…”