Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention

Significance Statement Percutaneous coronary intervention is linked with greater risk of AKI incidence; however, differences in this link by race remain less clear. This study quantified the association of race (White, Black, or other) with odds for AKI incidence within 7 days after percutaneous coronary intervention. After adjustment for demographics, comorbidities, medications, and procedural characteristics, the study found that, compared with Whites, odds for AKI incidence were substantially greater among Black but not other patients. Racial difference in odds for AKI incidence after percutaneous coronary intervention did not differ by baseline kidney function. These findings highlight the need to investigate factors that predispose Black individuals to greater risk for AKI after percutaneous coronary intervention. Background Undergoing percutaneous coronary intervention (PCI) is a risk factor for AKI development, but few studies have quantified racial differences in AKI incidence after this procedure. Methods We examined the association of self-reported race (Black, White, or other) and baseline eGFR with AKI incidence among patients who underwent PCI at Duke University Medical Center between January 1, 2003, and December 31, 2013. We defined AKI as a 0.3 mg/dl absolute increase in serum creatinine within 48 hours, or ≥1.5-fold relative elevation within 7 days post-PCI from the reference value ascertained within 30 days before PCI. Results Of 9422 patients in the analytic cohort (median age 63 years; 33% female; 75% White, 20% Black, 5% other race), 9% developed AKI overall (14% of Black, 8% of White, 10% of others). After adjustment for demographics, socioeconomic status, comorbidities, predisposing medications, PCI indication, periprocedural AKI prophylaxis, and PCI procedural characteristics, Black race was associated with increased odds for incident AKI compared with White race (odds ratio OR, 1.79; 95% confidence interval 95% CI, 1.48 to 2.15). Compared with Whites, odds for incident AKI were not significantly higher in other patients (OR, 1.30; 95% CI, 0.93 to 1.83). Low baseline eGFR was associated with graded, higher odds of AKI incidence ( P value for trend <0.001); however, there was no interaction between race and baseline eGFR on odds for incident AKI ( P value for interaction = 0.75). Conclusions Black patients had greater odds of developing AKI after PCI compared with White patients. Future investigations should identify factors, including multiple domains of social determinants, that predispose Black individuals to disparate AKI risk after PCI.