Kidney Week

Abstract: SA-PO001

AKI Following Coronary Angiography: Survival and Development of CKD

Session Information

• AKI Clinical: Epidemiology and Outcomes
  November 04, 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

• Helgason, Dadi, University of Iceland, Reykjavik, Iceland

Dadi Helgason,

• Long, Thorir E., University of Iceland, Reykjavik, Iceland

Thorir E. Long,

• Helgadóttir, Sólveig, Akademiska Hospital Uppsala University, Uppsala, Sweden

Sólveig Helgadóttir,

• Palsson, Runolfur, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland

Runolfur Palsson,

• Sigurdsson, Gisli H., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland

Gisli H. Sigurdsson,

• Gudbjartsson, Tomas, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland

Tomas Gudbjartsson,

• Gudmundsdottir, Ingibjorg J., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland

Ingibjorg J. Gudmundsdottir,

• Sigurdsson, Martin I., Duke Univeristy Medical Center, Durham, North Carolina, United States

Martin I. Sigurdsson,

• Indridason, Olafur S., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland

Olafur S. Indridason,

Background

Acute kidney injury (AKI) is a recognized complication following coronary angiography (CA) and has been associated with adverse short-term outcomes. We studied the association of AKI following CA with survival and the development and/or progression of chronic kidney disease (CKD).

Methods

This was a retrospective study of patients undergoing CA in Iceland in 2008-2015. Excluded were patients on chronic dialysis, those without baseline serum creatinine (SCr) and patients who underwent open heart surgery in the first 3 days following CA. AKI was defined according to the KDIGO SCr criteria, CKD was defined as eGFR <60 mL/min/1.73 m² for at least 3 months, and progression of CKD as worsening of at least one stage sustained over 90 days. Clinical information was obtained from hospital medical records and a prospective CA registry (SCAAR-Swedeheart) and mortality data from Statistics Iceland. Survival was estimated with Kaplan-Meier method and compared to non AKI patients for the whole group (log rank test) and after 1:1 propensity score matching (Klein test).Cox proportional hazards model was used to determine predictors of CKD development/progression.

Results

AKI was diagnosed in 251 out of 13465 cases (1.9%). The 30-day mortality was 23.1% vs. 1.1%, and 1-year survival was 68.6% vs. 97.1%, in the AKI and non-AKI group, respectively (p<0.0001). After excluding patients who died within 30 days, the AKI patients had worse 1-year survival compared with a propensity score-matched control group, or 89.2% vs. 96.2% (p=0.03). While 2343 patients (17.4%) had CKD at baseline,1935 of the 13465 cases (14.4%) developed incident CKD or progression of pre-existing CKD following CA, with a median time of follow-up of 3.5 (range 0.2-8.0) years. In multivariate analysis, AKI was a predictor of development/progression of CKD (HR 2.5; 95%-CI: 2.0-3.1).

Conclusion

Short-term mortality of patients with AKI following CA is high. However, even after excluding early deaths, AKI appears associated with less favorable long-term survival and the development and/or progression of CKD.

Funding

• Government Support - Non-U.S.