Why the study?
There is ongoing controversy surrounding the precise definition of CA-AKI, and limited research on the association between different definitions and prognosis specifically in patients with CKD.
Does the definition of contrast-associated acute kidney injury (CA-AKI A vs. CA-AKI B) affect the association with and population attributable risk for long-term all-cause mortality in patients with chronic kidney disease undergoing coronary angiography?
Does the definition of contrast-associated acute kidney injury (CA-AKI A vs. CA-AKI B) affect the association with and population attributable risk for long-term all-cause mortality in patients with chronic kidney disease undergoing coronary angiography?
In CKD patients undergoing coronary angiography, contrast-associated acute kidney injury is strongly associated with increased long-term mortality and similar population attributable risks regardless of which standard diagnostic definition is applied.
Answers are grounded in this paper and cite their sources.
Both CA-AKI definitions associate with higher long-term mortality in CKD; leaves open which definition best guides risk stratification.
Background: Contrast-associated acute kidney injury (CA-AKI) is a prevalent complication following coronary angiography (CAG). However, there is ongoing controversy surrounding its precise definition. Although previous studies have demonstrated the successful application of appropriate definitions in managing high-risk CA-AKI patients, there remains limited research on the association between different definitions and prognosis specifically in patients with chronic kidney disease (CKD). Methods: A total of 4197 CKD patients undergoing coronary angiography (CAG) were included in this study. Two definitions of contrast-associated acute kidney injury (CA-AKI) were used: CA-AKI A , which was defined as an increase of ≥ 0.5 mg/dL or > 25% in serum creatinine (SCr) from baseline within 72 hours after CAG, and CA-AKI B , which was defined as an increase of ≥ 0.3 mg/dL or > 50% in SCr from baseline within 48 hours after CAG. Cox regression analysis was employed to assess the association between these two definitions and long-term mortality. Additionally, population attributable risks (PARs) were calculated to evaluate the impact of CA-AKI definitions on long-term prognosis. Results: During the median follow-up period of 4.70 (2.50– 7.78) years, the overall long-term mortality was 23.6%, and the long-term mortality in patients with CA-AKI according to both CA-AKI A and CA-AKI B criteria were 33.5% and 33.8%, respectively. We found that CA-AKI A (HR: 1.45, 95% CI: 1.23– 1.70, p< 0.001) and CA-AKI B (HR: 1.44, 95% CI: 1.23– 1.69, p< 0.001) were associated with long-term mortality. The PARs were the highest for CA-AKI A (5.87%), followed by CA-AKI B (5.70%). Conclusion: Contrast-associated acute kidney injury (CA-AKI) is a frequently observed complication in CKD patients undergoing coronary angiography (CAG), and both definitions of CA-AKI are significantly correlated with a poor long-term prognosis. Consequently, in the clinical management of CKD patients, it is crucial to prioritize CA-AKI, irrespective of the specific CA-AKI definition used.
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Feng et al. (2024) studied this question.
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