The Incidence and the Prognostic Impact of Acute Kidney Injury in Acute Myocardial Infarction Patients: Current Preventive Strategies

Abstract

Acute kidney injury (AKI) is one of the most common complications during hospitalization in various clinical settings. The goal of this review was to assess the incidence of AKI in acute myocardial infarction patients (AMI), how this incidence is affected by the diverse definitions, and if there is variability in the reported rates over recent years. Additionally, we sought to appraise the impact of AKI on short- and long-term prognosis of these patients. Finally, we report on the current preventive measures as they are suggested in the current guidelines of various societies, we comment on the evidence that support them, and we review the literature for other proposed therapeutic strategies, which either failed to prove their efficacy or they are not adequately confirmed yet. Due to the heterogeneity in AKI definition and in the population studied of the published data, the incidence of AKI ranged from 5.2 to 59%. A recent meta-analysis reported a median value of 15.8%. All studies assessing AKI-related prognosis in AMI patients suggested that presence of AKI has detrimental effect on patients prognosis, raising mortality two- to threefold not only during the 30 first days but also during the first year after the acute event. Various treatment modalities have been proposed for prevention of AKI in AMI patients; however, the majority of them failed to prove their efficacy in the clinical trial arena. Hydration, use of iso- or low-osmolar agents at the lowest possible dose during coronary interventions, and use of statins have been proposed among others. Nonetheless, the prevalence of AKI after an AMI still remains high today and therefore it is crucial for the practicing physician to be aware of its presence and for the scientific community to identify novel measures for a more efficacious prevention.

Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study

“…Recommendations to prevent contrast-induced AKI include the use of iso-osmolar or low-osmolar contrast media in the lowest possible dose and hydration with I.V. crystalloid fluids [5,7,14]. The major finding of our study is that AKI developed in 13.9% of high-risk STEMI patients, despite the preventive measures were taken.…”

“…Current guidelines provide a number of recommendations to prevent contrast-induced AKI, including the use of iso-osmolar or low-osmolar (water-soluble) contrast media in the lowest possible dose, avoidance of nephrotoxic drugs, and hydration with intravenous (I.V.) crystalloid fluids [5,7,14].…”

High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational Study

“…The occurrence of AKI in AMI is a multifactorial event that is promoted by underlying renal dysfunction, but it is often influenced by multiple contributing factors, such as hemodynamic impairment and use of contrast agents [3,4]. An early risk stratification for AKI is important because it might identify high-risk patients who could benefit from preventive measures, such as adequate hydration and limitation of contrast dose [5,6].…”

Adaptive Autophagy Offers Cardiorenal Protection in Rats with Acute Myocardial Infarction

“…At present, AMI accounts for the highest proportion of coronary heart disease in China [1]. Studies have shown that kidney injury is considered to be a common detrimental event of AMI and frequently associated with high mortality [2,3]. What is more, it has been reported that chronic kidney disease occurred in 45-63% of patients with congestive heart failure (CHF), and deterioration of renal function is also an important cause of heart failure, resulting in a poor prognosis, even death [4,5].…”