Population attributable risk estimates of risk factors for contrast-induced acute kidney injury following coronary angiography: a cohort study

Abstract

Background: Contrast-induced acute kidney injury (CI-AKI) is a common complication with poor outcomes following coronary angiography (CAG) or percutaneous coronary intervention (PCI). However, no study has explored the population attributable risks (PARs) of the CI-AKI risk factors. Therefore, we aimed to identify the independent risk factors of CI-AKI and estimate their PARs. Methods: We analyzed 3450 consecutive patients undergoing CAG/PCI from a prospective cohort in Guangdong Provincial People's Hospital. CI-AKI was defined as a serum creatinine elevation ≥50% or 0.3 mg/dL from baseline within the first 48 to 72 h after the procedure. Independent risk factors for CI-AKI were evaluated through stepwise approach and multivariable logistic regression analysis, and those that are potentially modifiable were of interest. PARs of independent risk factors were calculated with their odds ratios and prevalence among our cohort. Results: The overall incidence of CI-AKI was 7.19% (n = 248), which was associated with increased long-term mortality. Independent risk factors for CI-AKI included heart failure (HF) symptoms, hypoalbuminemia, high contrast volume, hypotension, hypertension, chronic kidney disease stages, acute myocardial infarction and age > 75 years. Among the four risk factors of interest, the PAR of HF symptoms was the highest (38.06%), followed by hypoalbuminemia (17.69%), high contrast volume (12.91%) and hypotension (4.21%). Conclusions: These modifiable risk factors (e.g., HF symptoms, hypoalbuminemia) could be important and costeffective targets for prevention and treatment strategies to reduce the risk of CI-AKI. Intervention studies targeting these risk factors are needed.

Anemia is associated with increased risk of contrast‑induced acute kidney injury: A Systematic Review and Meta-analysis

“…The studies meeting all the following criteria were included in this meta-analysis [ 1 ]: observational study [ 2 ]; explored the relationship between anemia and CI-AKI in patients who underwent coronary angiography with or without percutaneous coronary intervention (PCI); and [ 3 ] reported outcomes with the adjusted odds ratios (ORs) or relative risks (RRs) with 95% confidence intervals (CIs). If more than one studies enrolled the overlapping population, we chose the newly published study.…”

“…Coronary angiography has been widely applied in the diagnosis and therapy of coronary artery disease (CAD) for several decades [ 1 ]. Unfortunately, many clinical studies reported that coronary angiography could significantly increase the risk of contrast-induced acute kidney injury (CI-AKI) [ 1 , 2 ]. The reported incidences of CI-AKI were distinct across different studies, ranging from 2% to 30%.…”

A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

“…Comparing with the Mehran score, the current nomogram has several strengths. First, our previous study showed that the CI-AKI definition of this study has higher population attributable risk (PAR) than that of the CI-AKI definition of the Mehran score, which means the current CI-AKI definition has better prognostic value [36]. Second, the current nomogram with only 4 variables was established for CHF patients specifically.…”

Current approach to contrast nephropathy

“…Mechanisms such as free oxygen radical damage, diuresis caused by contrast, increased urinary viscosity, infl ammation, direct toxicity, tubular toxicity, increased oxygen consumption and renal vasoconstriction are involved in the pathogenesis [5,6].…”

“…Renal disease history, diabetes and advanced age are the most common risk factors. However, chronic heart failure, hypertension, dehydration, nephrotoxins (aminoglycoside, nonsteroidal anti-infl ammatory, cyclosporine), anemia, periprocedural bleeding and female gender are other risk factors [5].…”