Abstract: FR-PO050

Timing of AKI after Urgent Percutaneous Coronary Intervention and Adverse Outcomes: The PATTERN Study

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

  • Tan, Thida C., Kaiser Permanente Northern California, Oakland, California, United States
  • Leong, Thomas, Kaiser Permanente Northern California, Oakland, California, United States
  • Lundstrom, Robert J, Kaiser Permanente Northern California, Oakland, California, United States
  • Rana, Jamal S, Kaiser Permanente Northern California, Oakland, California, United States
  • Watson, Douglas J, CSL Behring, King of Prussia, Pennsylvania, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
Background

Conflicting evidence exists about the frequency and outcomes associated with acute kidney injury (AKI) after percutaneous coronary interventions (PCI). Limited insights also exist about whether the timing of AKI influences outcomes after PCI in contemporary populations. We examined the association between AKI at 12 and 24 hours post-PCI with subsequent renal and mortality outcomes.

Methods

We identified all adult members within Kaiser Permanente Northern California undergoing urgent PCI from 2008-2013 who had both pre- and post-PCI serum creatinine data. Patients with prior dialysis, renal transplant or estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2 were excluded. AKI was defined as a ≥50% relative increase or ≥0.3 mg/dL increase in post- vs. pre-PCI serum creatinine measures at 12 (±6) and 24 (±6) hours post-PCI. We ascertained post-discharge significant loss of renal function (defined as a 50% decrease from baseline eGFR or development of ESRD) and all-cause death up to 1 year post-PCI based on data from electronic health records. We used Cox regression to evaluate the independent association between timing of AKI and outcomes after adjustment for a high-dimensional propensity score for developing AKI and pre-PCI eGFR and proteinuria.

Results

Among 8522 urgent PCI patients, mean age was 67 years, with 29% were women, and 21% minorities. AKI was documented in 1.8% of patients at 12 hours and 1.6% at 24 hours post-PCI. In multivariable Cox models, the risk of all-cause death up to 1 year was similarly high for AKI at 12 hours (adjusted hazard ratio [HR] 3.35, 95%CI:2.08-5.40) and 24 hours (HR 3.68, 2.18-6.21) post-PCI. In contrast, AKI at 24 hours post-PCI (HR 4.56, 2.37-8.79) was more strongly associated with significant loss of kidney function at 1-year than was AKI at 12 hours (HR 2.27, 1.19-4.32) post-PCI.

Conclusion

In a large, community-based population undergoing urgent PCI, AKI at 12 and 24 hours post-PCI were independently associated with high excess mortality at 1-year to a similar degree, while AKI at 24 hours was more strongly associated with subsequent significant loss of kidney function at 1 year compared with AKI at 12 hours. Studies are needed to determine whether prevention or treatment of AKI after PCI can mitigate the excess risks of death and renal function loss.

Funding

  • Commercial Support