Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography.
BACKGROUND
Acute kidney injury (AKI) is associated with early mortality after percutaneous coronary revascularization procedures, but its prognostic relevance to long-term clinical outcomes remains controversial.


RESULTS
We conducted a retrospective study of 14782 adults who received coronary angiography in the province of Alberta, Canada, between 2004 and 2006. AKI was identified on the basis of changes in serum creatinine concentration within 7 days of the procedure according to AKI Network criteria. The associations between AKI and long-term outcomes, including mortality, end-stage renal disease, and cardiovascular and renal hospitalizations, were studied with the use of Cox regression of multiple failure times. The adjusted risk of death increased with increasing severity of AKI; compared with no AKI, the adjusted hazard ratio for death was 2.00 (95% confidence interval, 1.69 to 2.36) with stage 1 AKI and 3.72 (95% confidence interval, 2.92 to 4.76) with stage 2 or 3 AKI. The adjusted risk of end-stage renal disease requiring renal replacement therapy also increased according to the severity of AKI (hazard ratio, 4.15 [95% confidence interval, 2.32 to 7.42] and 11.74 [95% confidence interval, 6.38 to 21.59], respectively), as did the risks of subsequent hospitalizations for heart failure and acute renal failure.


CONCLUSIONS
These findings inform the controversy surrounding AKI after angiography, demonstrating that it is a significant risk factor for long-term mortality, end-stage renal disease, and hospitalization for cardiovascular and renal events after coronary angiography.
Department of Medicine, University of Calgary, Calgary, Canada. mjames@ucalgary.ca
Matthew T
MT
James
William A
WA
Ghali
Merril L
ML
Knudtson
Pietro
P
Ravani
Marcello
M
Tonelli
Peter
P
Faris
Neesh
N
Pannu
Braden J
BJ
Manns
Scott W
SW
Klarenbach
Brenda R
BR
Hemmelgarn
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology*; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography / Q000009:adverse effects* / Q000706:statistics & numerical data*; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D003404:Creatinine