Renalism: an obstacle to left heart catheterization in chronic kidney disease patients

Background “Renalism” is a term defining the therapeutic nihilism that leads to patients with kidney disease waiting longer for effective interventions to reach them; in this context is also inscribed the reluctance of clinicians to conduct contrast-based studies such as left heart catheterization on individuals with chronic kidney disease (CKD). Non-ST-elevation myocardial infarction (NSTEMI) often requires left heart catheterization, and delay can lead to increased mortality and adverse cardiovascular outcomes. Methods The National Inpatient Sample Database 2016–2018 was used to sample patients presenting with NSTEMI. Baseline demographics and comorbidities were collected using ICD-10-codes. Patients below 18 years old, with missing data, and with kidney failure were excluded. Patients were stratified into CKD 1–2 vs CKD 3–5. 1:1 propensity score matching was performed to match the two cohorts. Mortality and cardiovascular outcomes were compared in patients with CKD 3–5 who underwent left heart catheterization and those who did not. Results Of 427 593 NSTEMI patients, 79 284 had CKD 3–5. CKD 3–5 patients were less likely to undergo left heart catheterization and had increased mortality. After matching, CKD 3–5 was independently associated with fewer left heart catheterizations. During regression analysis, CKD 3–5 patients that underwent left heart catheterization were 1.93 times less likely to have in-hospital mortality compared to patients that did not undergo left heart catheterization. Additionally, left heart catheterization in CKD 3–5 patients was also associated with decreased cardiovascular outcomes and acute kidney injury (AKI) (P < .001). Conclusion Alteration in practice-based guidelines due to the risk of contrast-associated acute kidney injury (CA-AKI) leads to less left heart catheterization in patients with CKD and increased mortality and adverse cardiovascular outcomes. Further studies are needed to evaluate the risks and benefits of contrast-based interventions in this patient cohort.