Abstract: FR-PO070

AKI Following CABG versus PCI in Advanced CKD Patients

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Gaipov, Abduzhappar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, KANAGAWA, Japan
  • Akbilgic, Oguz, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Rhee, Connie, University of California Irvine, School of Medicine, Orange, California, United States
  • Canada, Robert B., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
Background

Previous studies reported that GABG is associated with reduced risk of mortality and repeat revascularization in mild-to-moderate CKD, ESRD, and in diabetics. However, the relative risk of acute kidney injury (AKI) associated with CABG vs. PCI in patients with advanced CKD is not clear.

Methods

We examined 655 US veterans with incident ESRD who underwent a first CABG or PCI up to 5 years prior to dialysis initiation. Stages of AKI following the procedures were classified according to the Acute Kidney Injury Network classification. The association of CABG vs. PCI with AKI was examined in multivariable adjusted logistic regression analyses.

Results

472 patients underwent CABG and 183 patients underwent PCI. Mean age was 63.7 (SD=8.1) years, 99% were male, 76.5% were white, and 21.8% were African Americans. The pre-procedure eGFR and the incidence of AKI in the CABG vs PCI group were 36.4 (IQR=23.5–58.2) vs. 33.2 (IQR=20.6–48.6) ml/min/1.73m2 and 75.2% vs 30.6%, respectively. The incidence of all stages of AKI were higher after CABG compared to PCI (Figure). CABG was associated with a 5.1-fold higher crude risk of AKI (odds ratio and 95%CI: 5.1, 2.9–8.8; p<0.001), which remained significant after multivariable adjustments (5.2, 2.9–9.2; p<0.001).

Conclusion

CABG was associated with a 5-fold higher risk of AKI compared to PCI in patients with advanced CKD. Despite other benefits of CABG over the PCI, the extremely high risk of AKI associated with GABG should be considered in this vulnerable population when deciding on the optimal revascularization strategy.

Funding

  • NIDDK Support