2-043 Acute kidney injury in patients presenting with acute coronary syndrome, with and without diabetes mellitus

Introduction Acute kidney injury (AKI) remains an important complication associated with acute cardiovascular insult. It may be associated with increased hospital stay, morbidity and mortality. Diabetes mellitus (DM) results in chronic microvascular damage of the kidney and is a significant risk factor for the development of AKI. Assessing the prevalence of AKI in patients with acute coronary syndrome (ACS) as well as in the period following discharge, with and without DM, are important factors in early identification of high-risk individuals and timely initiation of appropriate therapies. Purpose To assess the (i) incidence of AKI in all patients presenting with an ACS, and (ii) incidence of further AKI in the 12 months following successful discharge, based on the presence or absence of DM. Methods A single centre, retrospective, registry analysis of patients presenting with an ACS, admitted between July 2020 and June 2021. Baseline characteristics and presence of AKI was noted during admission and then during the 12 months after discharge. Intergroup comparison was made using Pearson's Chi Square, Wilcoxon ranked sum and Fishers exact test where applicable, with p<0.05 as significant. All data was recorded in Excel Software and then analysed in R. Results Of 1,012 individuals admitted, 990 patients met eligibility criteria. 14.2% (141/990) had an AKI during admission, with majority having stage 1 (12.2% [121/990] and less frequently, stages 2 (0.6% [6/990]) and 3 (1.4% [14/990]). These individuals had a longer length of in-hospital stay (7.5 days [3.2–14.3] vs 3.0 days [1.5–5.8], relative ratio (RR) 2.5, p<0.001) and had a higher in-hospital mortality (22.0% [31/141] vs 2.8% [24/849], RR 7.9, p<0.001). Based on severity of AKI at admission, in-hospital was mortality was 16.5% (20/121), 50.0% (3/6) and 57.1% (8/14) for stages 1, 2 and 3 respectively (table 1). 315 (31.8%) patients had DM and were more likely to have an AKI at admission (20.0% [63/315] vs 11.6% [78/675], RR 1.7, p<0.001), in particular stage 3 (2.9% [9/315] vs 0.7% [5/675], RR 4.1, p=0.017) (table 2). Of those successfully discharged (n=935), 9.2% (86) individuals had at least one episode of AKI in the 12 months after discharge, more common in those with DM (15.0% [44/294] vs 6.6% [42/641], RR 2.3, p<0.001). Conclusion Patients presenting with ACS continue to be complicated by events of AKI which are more common in those with DM. These individuals remain at higher risk of further events and therefore would benefit from closer continued monitoring in the primary care setting after discharge and may benefit from the early initiation of cardio-renal protective agents in particular the sodium-glucose co-transporter inhibitors and glucagon-like polypeptide-1 receptor agonists, which have demonstrated composite renal outcome benefit in recent randomised controlled studies.