title: Association between acute kidney injury and in-hospital mortality in patients undergoing percutaneous coronary interventions.
abstract: BACKGROUND
  Acute kidney injury (AKI) post percutaneous coronary intervention (PCI) is associated with increased mortality but both death and AKI share common risk factors. Moreover, the effect of a high contrast dose, a known modifiable risk factor for AKI, on mortality is unknown. The aim of our study was to analyze the association between AKI and in-hospital mortality post PCI after adjustment for confounding by common risk factors.
  
  
  RESULTS
  This study was performed using a regional registry of all patients undergoing PCI in Michigan. Primary end points were AKI (serum creatinine increase >0.5 mg/dL) and all-cause in-hospital mortality. Propensity matching was performed, with each AKI patient matched to 4 controls. Attributable risk fraction and the exposed index number of AKI for mortality were calculated within the propensity-matched cohort. Between 2010 and 2013, 92 317 patients underwent PCI, of whom 2141 (2.3%) developed AKI. We matched 1371/2141 patients with AKI to 5484 controls. AKI was strongly associated with mortality (odds ratio=12.52, 95% confidence interval 9.29-16.86) in the propensity-matched cohort. The attributable risk fraction for mortality of AKI was 31.4% (95% confidence interval 26.8%-37.5%), and one death could be prevented for every 9 cases of AKI successfully avoided. The independent impact of a high contrast dose at time of PCI on in-hospital mortality risk was weak (adjusted odds ratio 1.19, 95% confidence interval 0.97-1.45).
  
  
  CONCLUSIONS
  Nearly one-third of the in-hospital mortality post PCI is attributable to AKI. Preventing 9 cases of AKI could potentially prevent one death. These study findings stress the need for developing effective AKI preventive strategies beyond minimization of contrast dose.
authors.affiliation: From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.).
authors.forename: Judith
authors.initials: J
authors.lastname: Kooiman
authors.affiliation: From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.).
authors.forename: Milan
authors.initials: M
authors.lastname: Seth
authors.affiliation: From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.).
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.).
authors.forename: Michael
authors.initials: M
authors.lastname: Heung
authors.affiliation: From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.).
authors.forename: David
authors.initials: D
authors.lastname: Humes
authors.affiliation: From the Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, The Netherlands (J.K.); Division of Cardiovascular Medicine (M.S., B.K.N., H.S.G.) and Division of Nephrology (M.H., D.H.), Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and VA Ann Arbor Healthcare System, MI (B.K.N., H.S.G.). hgurm@med.umich.edu.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality*; D012042:Registries; D012307:Risk Factors
chemical_list: D003287:Contrast Media
keywords: contrast media; infarction; kidney; mortality; revascularization