title: Renal function at hospital admission and mortality due to acute kidney injury after myocardial infarction.
abstract: BACKGROUND
  The role of an impaired estimated glomerular filtration rate (eGFR) at hospital admission in the outcome of acute kidney injury (AKI) after acute myocardial infarction (AMI) has been underreported. The aim of this study was to assess the influence of an admission eGFR<60 mL/min/1.73 m(2) on the incidence and early and late mortality of AMI-associated AKI.
  
  
  METHODS
  A prospective study of 828 AMI patients was performed. AKI was defined as a serum creatinine increase of ≥ 50% from the time of admission (RIFLE criteria) in the first 7 days of hospitalization. Patients were divided into subgroups according to their eGFR upon hospital admission (MDRD formula, mL/min/1.73 m(2)) and the development of AKI: eGFR ≥ 60 without AKI, eGFR<60 without AKI, eGFR ≥ 60 with AKI and eGFR<60 with AKI.
  
  
  RESULTS
  Overall, 14.6% of the patients in this study developed AKI. The admission eGFR had no impact on the incidence of AKI. However, the admission eGFR was associated with the outcome of AMI-associated AKI. The adjusted hazard ratios (AHR, Cox multivariate analysis) for 30-day mortality were 2.00 (95% CI 1.11-3.61) for eGFR<60 without AKI, 4.76 (95% CI 2.45-9.26) for eGFR ≥ 60 with AKI and 6.27 (95% CI 3.20-12.29) for eGFR<60 with AKI. Only an admission eGFR of <60 with AKI was significantly associated with a 30-day to 1-year mortality hazard (AHR 3.05, 95% CI 1.50-6.19).
  
  
  CONCLUSIONS
  AKI development was associated with an increased early mortality hazard in AMI patients with either preserved or impaired admission eGFR. Only the association of impaired admission eGFR and AKI was associated with an increased hazard for late mortality among these patients.
authors.affiliation: Division of Nephrology, Hospital de Base, Sao Jose do Rio Preto Medical School (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil.
authors.forename: Rosana G
authors.initials: RG
authors.lastname: Bruetto
authors.forename: Fernando B
authors.initials: FB
authors.lastname: Rodrigues
authors.forename: Ulysses S
authors.initials: US
authors.lastname: Torres
authors.forename: Ana P
authors.initials: AP
authors.lastname: Otaviano
authors.forename: Dirce M T
authors.initials: DM
authors.lastname: Zanetta
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Burdmann
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate; D016277:Ventricular Function, Left
chemical_list: D003404:Creatinine