B-25 | Relationship Between Acute Kidney Injury, Fluid Administration, and Chronic Kidney Disease in Patients Undergoing Percutaneous Coronary Intervention

There are limited data on how baseline kidney function and fluid balance are related to acute kidney injury (AKI) after percutaneous coronary intervention (PCI). Patients who underwent PCI from 2009-2017 were identified from our institute's National Cardiovascular Disease Registry CathPCI Database. Patients were stratified by CKD Stages 1 (eGFR≥90%), 2 (60-89%), 3a (45-59%), 3b (30-44%), 4 (16-29%), and 5 (≤15%). Net fluid balance (input – output) after PCI was recorded. The outcome was AKI, defined by Acute Kidney Injury Network as an absolute increase in serum creatinine (Cr) levels of at least 0.3 mg/dL or a relative increase of Cr by 50% within 72 hours after PCI. AKI requiring dialysis was defined separately ("AKI-D"). Among 13,537 PCIs, there were 943 AKI events (6.97%). The rates of AKI and AKI-D increased in a stepwise manner across CKD Stages 1-5 (P<0.0001). After multivariable adjustment, CKD Stages 3b-5 remained independent predictors of AKI (P<0.05) (Figure). Those with CKD stages 3b-5 had a more net negative fluid balance within 24 hours before and after PCI, compared to CKD stages 1-3a (P<0.05). Individuals who developed AKI had a more net negative fluid balance within 24 hours post PCI (median -413.45 mL, IQR -2411.25-633.65), compared to those who did not develop AKI (median -350, IQR -1165-309) (P<0.05). Worse baseline CKD independently predicts increased risk of AKI after PCI. A more negative fluid balance within 24 hours after PCI predisposes to AKI. This suggests that fluid administration post-PCI may reduce AKI, especially in individuals with baseline CKD.