Risk Factors And Prognosis Of Acute Kidney Disease Following Coronary Angiography

Background:Contrast-associated acute kidney injury(CA-AKI)after coronary angiography(CAG)has a high incidence in patients with cardiovascular disease and has been proven to be associated with the risk of death and chronic kidney disease.Acute kidney disease(AKD)is a clinical syndrome temporally intermediate between acute kidney injury and chronic kidney disease,which may be sub-acute kidney injury or persistent impairment of renal function after acute kidney injury and it is associated with poor prognosis.The prognosis and mechanism of AKD after coronary angiography are not clear.Therefore,it is important to evaluate the outcome of patients with AKD after coronary angiography and find out the independent risk factors,which could help early assess the risk of AKD and take measures to improve the prognosis of these patients.Method:A total of 10,473 patients admitted to the Department of Cardiovascular Medicine at five regional central tertiary teaching hospitals in southern China for coronary intervention between January 2007 and December 2020 were included in the study.The primary endpoint was AKD,defined as a 50%increase from baseline in serum creatinine levels occurring within 7 to 90 days after coronary angiography.Secondary end points were all-cause mortality and chronic kidney disease.Univariate and multivariate Cox regression were used to assess the relationship between AKD and long-term prognosis and chronic kidney disease and calculate the hazard ratio(HR).Univariate and multivariate logistic regression were used to assess the risk factors of AKD.Logistic regression was used to investigate the relationship between N-terminal pro-B-type natriuretic peptide(NT-proBNP)and AKD.Results:A total of 1144 patients(10.9%)developed AKD,and those who developed AKD were older and more likely to have congestive heart failure,atrial fibrillation,anemia,and have a higher incidence of contrast-associated acute kidney injury.Patients with AKD have a higher risk of long-term all-cause mortality(HR:1.18,95%CI:1.03-1.37)and new-onset chronic kidney disease(HR:5.07,95%CI:4.65-5.53),and patients with heart failure and acute myocardial infarction may have a worse prognosis.There are several independent risk factors for AKD(systolic blood pressure,anemia,total cholesterol,statin therapy,etc.),and the use of diuretic use(OR:1.85,95%CI:1.19-2.97)and multi-vessel coronary artery disease(OR:4.05,95%CI:1.26-14.30)are strong risk predictors of AKD in patients with heart failure and contrast-associated acute kidney injury,respectively.In addition,NT-proBNP is independently associated with the development of AKD(OR:1.13,95%CI:1.07-1.20).Conclusion:1.AKD is associated with long-term poor prognosis in patients after coronary angiography.2.The risk factors of AKD after coronary angiography in our study may be important targets for early intervention in high-risk patients in the future.3.Our study verifies the correlation between NT-proBNP and AKD inpatients after coronary angiography,which could conveniently and effectively help to assess the risk of AKD and take preventive strategies.