Predicting the incidence of chronic kidney disease in patients with myocardial infarction and acute kidney injury

Abstract

Aim. To estimate the incidence of chronic kidney disease (CKD) and develop a calculator to estimate the CKD probability in patients with myocardial infarction (MI) and acute kidney injury (AKI).Material and methods. A total of 193 patients with MI aged 34-79 years were examined: 123 patients with MI and signs of AKI, 70 patients without AKI. In all patients, the levels of C-reactive protein, troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), microalbuminuria (MA), creatinine, and glomerular filtration rate (GFR) were determined. In the presence of AKI criteria on the 3rd day and at discharge, the level of kidney injury molecule-1 (KIM-1) molecule and interleukin-18 was examined in the urine. Six months after discharge, GFR was assessed over time. Patients of both groups underwent coronary angiography with stenting of infarct-related artery.Results. The GFR at admission in patients with AKI was lower than in the group without AKI with normal creatinine levels. Following correlations between AKI and markers of cardiovascular events were revealed: KIM-1 and NT-proBNP (r=0,29 p=0,031), GFR and NT-proBNP (r=-0,22 p=0,015), NT-proBNP and IL-18 (r=0,18 p=0,045), MA with troponin I and CRP (r=0,20 p=0,048 and r=0,29 p=0,001). After six months, persistent renal function decline was more frequently diagnosed in patients with acute MI and AKI on index hospitalization. An equation for a multifactorial model for CKD risk was created: P(CKD)=exp(z)/(1+exp(z)), z=-1,113092e+01 — 4,082006e-02 * troponin I + 8,553826e-04 * NT-proBNP (discharge) + 1,620188e-01 * age + 3,411724e-02 * systolic blood pressure -7,753111e-03 * MA. ROC analysis revealed the most reliable sensitivity of 83% and specificity of 88,2% for the threshold value of CKD probability of 86,1%.Conclusion. Patients with MI and AKI have a significant risk of CKD within 6 months after ACS. The created mathematical model and calculator determine the likelihood of CKD.