The Definition of “Acute Kidney Injury” Following Percutaneous Coronary Intervention and Cardiovascular Outcomes

Skalsky, Keren; Levi, Amos; Bental, Tamir; Vaknin‐Assa, Hana; Assali, Abid; Steinmetz, Tali; Kornowski, Ran; Perl, Leor

doi:10.1016/j.amjcard.2021.06.033

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…AKI was defined as an absolute increase in serum creatinine (≥0.5 mg/dL) or above 1.5 mg/dL (when no prior level existed in patients without a diagnosis of chronic kidney disease) or new renal replacement therapy upon admission with ACS. It should be stated that a gold standard for the definition of AKI and the ideal margins of absolute and relative increases in serum creatinine used for the definition is controversial [16]. As our study included not only contrast-induced AKI (CI-AKI) but rather all AKI in the context of ACS, even fewer data exists about the optimal definition.…”

Section: Study Design and Populationmentioning

confidence: 99%

“…As our study included not only contrast-induced AKI (CI-AKI) but rather all AKI in the context of ACS, even fewer data exists about the optimal definition. An increase of 0.5 mg/dL is one of the previously reported and accepted definitions that have been shown to be quite accurate [16,17] and is not the most strict or lenient, hence, it was chosen by us for this study. Regarding patients without a recent previous creatinine value, who did not have a diagnosis of chronic kidney disease, we chose the definition of creatinine above 1.5 mg/dL based on the previously reported definition of the relative increase in serum creatinine to ≥1.5 times baseline [18] assuming the baseline to be 1 mg/dL (which is close to the upper limit of normal values in both sexes).…”

Section: Study Design and Populationmentioning

confidence: 99%

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Acute Kidney Injury Following Admission with Acute Coronary Syndrome: The Role of Diabetes Mellitus

Shiyovich

Skalsky

Steinmetz

et al. 2021

JCM

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Purpose: To evaluate the role of diabetes mellitus in the incidence, risk factors, and outcomes of AKI (acute kidney injury) in patients admitted with ACS (acute coronary syndrome). Methods: We performed a comparative evaluation of ACS patients with vs. without DM who developed AKI enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2018. AKI was defined as an absolute increase in serum creatinine (³0.5 mg/dL) or above 1.5 mg/dL or new renal replacement therapy upon admission with ACS. Outcomes included 30-day major adverse cardiovascular events (MACE) and 1-year all-cause mortality. Results: The current study included a total of 16,879 patients, median age 64 (IQR 54–74), 77% males, 36% with DM. The incidence of AKI was significantly higher among patients with vs. without DM (8.4% vs. 4.7%, p < 0.001). The rates of 30-day MACE (40.8% vs. 13.4%, p < 0.001) and 1-year mortality (43.7% vs. 10%, p < 0.001) were significantly greater among diabetic patients who developed vs. those who did not develop AKI respectively, yet very similar among patients that developed AKI with vs. without DM (30-day MACE 40.8% vs. 40.3%, p = 0.9 1-year mortality 43.7 vs. 44.8%, p = 0.8, respectively). Multivariate analyses adjusted to potential confounders, showed similar independent predictors of AKI among patients with and without DM, comprising; older age, chronic kidney disease, congestive heart failure, and peripheral arterial disease. Conclusions: Although patients with DM are at much greater risk for AKI when admitted with ACS, the independent predictors of AKI and the worse patient outcomes when AKI occurs, are similar irrespective to DM status.

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Section: Study Design and Populationmentioning

confidence: 99%

Section: Study Design and Populationmentioning

confidence: 99%

Acute Kidney Injury Following Admission with Acute Coronary Syndrome: The Role of Diabetes Mellitus

Shiyovich

Skalsky

Steinmetz

et al. 2021

JCM

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“…In our study, the incidence of CA-AKI increased significantly from that under the old definition, 1.9%, to that under the new definition, 5.0%. In a recent report, the optimal definition of CA-AKI in predicting adverse cardiovascular outcomes and post-PCI mortality was compared according to four different definitions: an absolute elevation in the SCr of ≥ 0.3 mg/dL or ≥ 0.5 mg/dL at 48 h post PCI or a relative elevation of ≥ 25% or ≥ 50% 19 . They found that an absolute elevation of ≥ 0.3 mg/dL in the SCr 48 h post PCI predicted the outcomes most accurately.…”

Section: Discussionmentioning

confidence: 99%

A simple proteinuria-based risk score predicts contrast-associated acute kidney injury after percutaneous coronary intervention

Fujiwara

Ishii

Sobue

et al. 2022

Sci Rep

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Contrast-associated acute kidney injury (CA-AKI) is a complication of percutaneous coronary intervention (PCI). Because proteinuria is a sentinel marker of renal dysfunction, we assessed its role in predicting CA-AKI in patients undergoing PCI. A total of 1,254 patients undergoing PCI were randomly assigned to a derivation (n = 840) and validation (n = 414) dataset. We identified the independent predictors of CA-AKI where CA-AKI was defined by the new criteria issued in 2020, by a multivariate logistic regression in the derivation dataset. We created a risk score from the remaining predictors. The discrimination and calibration of the risk score in the validation dataset were assessed by the area under the receiver-operating characteristic curves (AUC) and Hosmer–Lemeshow test, respectively. A total of 64 (5.1%) patients developed CA-AKI. The 3 variables of the risk score were emergency procedures, serum creatinine, and proteinuria, which were assigned 1 point each based on the correlation coefficient. The risk score demonstrated a good discriminative power (AUC 0.789, 95% CI 0.766–0.912) and significant calibration. It was strongly associated with the onset of CA-AKI (Cochran-Armitage test, p < 0.0001). Our risk score that included proteinuria was simple to obtain and calculate, and may be useful in assessing the CA-AKI risk before PCI.

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“…When choosing an invasive strategy, measures should be taken to prevent acute chronic kidney injury and CIN, as those may increase the risk of major adverse cardiovascular events and mortality. The definition of acute kidney injury is based on an elevation of ≥0.3 mg/dL in creatinine levels 48 h post PCI [ 96 ], although recent publications suggest using serum and urine biomarkers for the early diagnosis of the complication, before the expected serum creatinine increases. Suggested biomarkers vary and include Cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), β2-microglobulin and inflammatory cytokines IL18 and TNFα [ 97 , 98 , 99 ].…”

Section: Acute Coronary Syndrome and Renal Failurementioning

confidence: 99%

Chronic Renal Failure and Cardiovascular Disease: A Comprehensive Appraisal

Skalsky

Shiyovich

Steinmetz

et al. 2022

JCM

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Coronary artery disease is highly prevalent in patients with chronic kidney disease. The concomitant renal disease often poses a major challenge in decision making as symptoms, cardiac biomarkers and noninvasive studies for evaluation of myocardial ischemia have different sensitivity and specificity thresholds in this specific population. Moreover, the effectiveness and safety of intervention and medical treatment in those patients is of great doubt as most clinical studies exclude patients with advance CKD. In the present paper, we discuss and review the literature in the diagnosis, treatment and prevention of CAD in the acute and chronic setting, in patients with CKD.

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The Definition of “Acute Kidney Injury” Following Percutaneous Coronary Intervention and Cardiovascular Outcomes

Cited by 4 publications

References 18 publications

Acute Kidney Injury Following Admission with Acute Coronary Syndrome: The Role of Diabetes Mellitus

Acute Kidney Injury Following Admission with Acute Coronary Syndrome: The Role of Diabetes Mellitus

A simple proteinuria-based risk score predicts contrast-associated acute kidney injury after percutaneous coronary intervention

Chronic Renal Failure and Cardiovascular Disease: A Comprehensive Appraisal

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