title: Risk factors and outcomes of acute kidney injury after intracoronary stent implantation.
abstract: BACKGROUND
  Acute kidney injury following percutaneous coronary intervention (PCI) is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury (AKI) in patients after intracoronary stent implantation are still unknown.
  
  
  METHODS
  A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included: 1) pre-operative ones: age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate (eGFR), hyperuricemia, proteinuria, emergency operation, hydration, medications (ACEI/ARBs, statins); 2) intraoperative ones: dose of contrast media, operative time, hypotension; and 3) postoperative one: hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis.
  
  
  RESULTS
  Of the 325 patients, 51(15.7%) developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters (left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration), emergency operation, intraoperative parameters (operative time, hypotension) and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age (OR=0.253, 95%CI=0.088-0.727), pre-operative proteinuria (OR=5.351, 95%CI=2.128-13.459), pre-operative left ventricular insufficiency (OR=8.704, 95%CI=3.170-23.898), eGFR≤60 ml/min/1.73 m(2) (OR=6.677, 95%CI=1.167-38.193), prolonged operative time, intraoperative hypotension (OR=25.245, 95%CI=1.001-1.034) were independent risk factors of AKI.
  
  
  CONCLUSIONS
  AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors of AKI.
authors.affiliation: Department of Emergency Medicine, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Fei
authors.initials: F
authors.lastname: He
authors.affiliation: Department of Emergency Medicine, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Emergency Medicine, First Affiliated Hospital, Wenzhou Medical College, Wenzhou 325000, China.
authors.forename: Zhong-Qiu
authors.initials: ZQ
authors.lastname: Lu
authors.affiliation: Department of Emergency Medicine, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Qing-Ling
authors.initials: QL
authors.lastname: Gao
authors.affiliation: Department of Emergency Medicine, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Du-Juan
authors.initials: DJ
authors.lastname: Sha
authors.affiliation: Department of Cardiology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Li-Gang
authors.initials: LG
authors.lastname: Pei
authors.affiliation: Department of Emergency Medicine, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Guo-Feng
authors.initials: GF
authors.lastname: Fan
keywords: Acute kidney injury; Intracoronary stent implantation; Outcome; Risk factor