Abstract: SA-PO520
Renalism: An Obstacle to Left Heart Catheterization in CKD Patients
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Wei, Chapman, Staten Island University Hospital, Staten Island, New York, United States
- Mustafa, Ahmad, Staten Island University Hospital, Staten Island, New York, United States
- Siddiqui, Fasih Sami, Staten Island University Hospital, Staten Island, New York, United States
- Grovu, Radu C., Staten Island University Hospital, Staten Island, New York, United States
- Khan, Shahkar, Staten Island University Hospital, Staten Island, New York, United States
- Rizvi, Taqi Ali, Staten Island University Hospital, Staten Island, New York, United States
- Afif, John Anthony, Staten Island University Hospital, Staten Island, New York, United States
- Wahbah Makhoul, Gennifer, Staten Island University Hospital, Staten Island, New York, United States
- Ling, Joanne, Staten Island University Hospital, Staten Island, New York, United States
- Asogwa, Nnedindu, Staten Island University Hospital, Staten Island, New York, United States
- Mustafa, Nawal, Staten Island University Hospital, Staten Island, New York, United States
- Weinberg, Mitchell, Staten Island University Hospital, Staten Island, New York, United States
- El-Charabaty, Elie, Staten Island University Hospital, Staten Island, New York, United States
- El Sayegh, Suzanne E., Staten Island University Hospital, Staten Island, New York, United States
Background
“Renalism” is the reluctance of clinicians to conduct contrast-based studies such as left heart catheterization (LHC) on individuals with chronic kidney disease (CKD). Non-ST-elevation myocardial infarction (NSTEMI) often requires LHC 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 less than 18 years old, missing data, and with end-stage renal disease were excluded. Patients were stratified into CKD 1-2 vs CKD 3-5. 1:1 propensity matching was performed to match the two cohorts. Mortality and cardiovascular outcomes were compared in CKD 3-5 patients who underwent LHC 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 have LHC and had increased mortality. After matching, CKD 3-5 was independently associated with less LHC. During regression analysis, CKD 3-5 patientsthat underwent LHC were 2.9 times less likely to have in-hospital mortality compared to patients that did not undergo LHC. Additionally, LHC in CKD 3-5 patients was also associated with decreased cardiovascular outcomes and acute kidney injury (p<0.001).
Conclusion
Alteration in practice-based guidelines due to risk of contrast-induced nephropathy leads to less LHC in CKD patients and increased mortality and adverse cardiovascular outcomes. Further studies are needed to evaluate the risks and benefits of contrast-based studies in this patient cohorts.
Outcomes of CKD Stage 3-5 patients that underwent left heart catheterization
| Outcomes | P-value | Odds Ratio | Lower 95% CI | Upper 95% CI |
| Unmatched | ||||
| Mortality | <0.001 | 0.390 | 0.352 | 0.432 |
| Acute Kidney Injury | <0.001 | 0.651 | 0.626 | 0.678 |
| Acute Heart Failure | <0.001 | 0.696 | 0.667 | 0.725 |
| Cardiac Arrest | <0.001 | 0.752 | 0.658 | 0.859 |
| Length of Stay (Coefficient) | <0.001 | -1.080 | -1.218 | -0.942 |
| Matched | ||||
| Mortality | <0.001 | 0.342 | 0.319 | 0.366 |
| Acute Kidney Injury | <0.001 | 0.724 | 0.702 | 0.746 |
| Acute Heart Failure | <0.001 | 0.838 | 0.814 | 0.864 |
| Cardiac Arrest | <0.001 | 0.731 | 0.666 | 0.803 |
| Length of Stay (Coefficient) | <0.001 | 0.396 | 0.295 | 0.498 |