title: Long-Term (3 Years) Prognosis of Contrast-Induced Acute Kidney Injury After Coronary Angiography.
abstract: Contrast-induced acute kidney injury (CI-AKI) after coronary angiography or interventions is relatively frequent and portends adverse outcomes. The lack of a "universally accepted" definition, however, limits the integration and comparison of available data. We aimed to detect the CI-AKI definition that best correlates with the occurrence of clinical events at long-term in a 3-year follow-up study of patients at intermediate-to-high risk for CI-AKI. Furthermore, we sought to describe the incidence and long-term evolution of persistent renal damage (PRD) after CI-AKI and clarify the role of early (<12 hours) increments of serum creatinine (SCr) in CI-AKI prediction. Among a total of 216 patients enrolled at our center and followed for a median of 37 months, CI-AKI was diagnosed in 18.1% of cases (SCr increment ≥25% of baseline), 7.4% (SCr increment ≥0.5 mg/dl), and in 17.1% (SCr increment ≥0.3 mg/dl), according to 3 different definitions. The third definition was the only one significantly associated with the occurrence of events at 3 years (Cox regression, p = 0.04). PRD at 30 days, as detected by the same cutoff, significantly and independently identified patients at risk of worst outcomes at 3 years (p = 0.04 at multivariate Cox regression). Furthermore, a slight 5% to 10% increment of SCr compared with baseline, occurring as early as 12 hours postprocedure, was confirmed as a strong predictor of inhospital CI-AKI occurrence. In conclusion, an absolute increase in SCr ≥0.3 mg/dl seems to be most clinically informative cutoff for CI-AKI and PRD detection.
authors.affiliation: Department of Cardiology, University of Verona, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pesarini
authors.affiliation: Department of Cardiology, University of Verona, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Lunardi
authors.affiliation: Department of Cardiology, University of Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ederle
authors.affiliation: Department of Cardiology, University of Verona, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Zivelonghi
authors.affiliation: Department of Cardiology, University of Verona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Scarsini
authors.affiliation: Department of Cardiology, University of Verona, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Gambaro
authors.affiliation: Department of Nephrology, University of Verona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lupo
authors.affiliation: Department of Cardiology, University of Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.affiliation: Department of Cardiology, University of Verona, Italy. Electronic address: flavio.ribichini@univr.it.
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007677:Kidney Function Tests; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003287:Contrast Media; D003404:Creatinine