Innocent, Guilty, and Acute Kidney Injury

Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

“…The relationship between contrast administration and AKI is highly variable, strongly influenced by baseline risks, comorbidities, and other potential causes (i.e., atheromatous embolic debris) [ 25 ]. Similarly, some authors have suggested that CA-AKI is observed in subjects with several comorbidities, worse clinical presentation, complicated course of the disease, and then the increased mortality could be determined not by CA-AKI itself, but by the interaction of several factors of which CA-AKI is a bystander [ 11 , 12 , 13 ]. Our analysis is focused on older MI patients undergoing invasive strategy and PCI and represents an ideal subset of patients to try to clarify the missing pieces of the puzzle.…”

“…Thus, it is not surprising that nearly one out of five older adults undergoing cardiac catheterization for acute MI experience CA-AKI with associated increased short-term mortality [ 10 ]. However, recent evidence challenged the dogma that considers CA-AKI to be a direct cause of serious adverse events as mortality, need of dialysis, or persistent kidney impairment, suggesting that it could be only a marker (or a more frequent complication) of patients at higher risk for these complications [ 2 , 11 , 12 , 13 ]. Trying to better elucidate the relationship between age, CA-AKI and mortality, we analyzed the occurrence and prognostic implication of CA-AKI in two prospective studies focused on patients aged 70 years or more admitted to hospital for acute coronary syndrome (ACS) and undergoing invasive treatment.…”