Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
J Nephrol. 2018 Oct;31(5):721-730. doi: 10.1007/s40620-018-0534-y. Epub 2018 Sep 5.
We studied the incidence and risk factors of acute kidney injury (AKI) following coronary angiography (CA) and examined short- and long-term outcomes of patients who developed AKI, including progression of chronic kidney disease (CKD).
This was a retrospective study of all patients undergoing CA in Iceland from 2008 to 2015, with or without percutaneous coronary intervention. All procedures were performed with iso-osmolar contrast. AKI was defined according to the SCr component of the KDIGO criteria. Patients without post-procedural SCr were assumed to be free of AKI. Incident CKD was defined as 90-day sustained estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m, and progression of CKD as worsening at least one stage sustained over 90 days.
AKI was detected in 231 of 13,561 cases (1.7%). There was an interaction between contrast dose and preexisting kidney function, where the risk for AKI was only significant at a dose > 150 mL in patients with baseline eGFR < 45 mL/min/1.73 m (OR 5.3, 95% CI 2.1-14.2). The AKI patients had worse short-and long-term survival, as well as elevated hazard of both new-onset CKD (HR 3.7, 95% CI 2.7-5.0) and progression of preexisting CKD (HR 2.0, 95% CI 1.5-2.6) over a median follow-up of 3.3 years (range 0.1-8.4 years), compared to a propensity score-matched control group.
For iso-osmolar contrast, the risk of AKI related to contrast dose was evident for higher amount of contrast in patients with baseline eGFR < 45 mL/min/1.73 m. In addition to association with adverse short- and long-term survival AKI had a strong association with new-onset or progression of CKD when patients were followed longitudinally.
我们研究了冠状动脉造影（CA）后急性肾损伤（AKI）的发生率和危险因素，并检查了发生 AKI 的患者的短期和长期结局，包括慢性肾脏病（CKD）的进展。
这是一项回顾性研究，纳入了 2008 年至 2015 年间在冰岛接受 CA 治疗的所有患者，无论是否进行经皮冠状动脉介入治疗。所有操作均使用等渗造影剂进行。AKI 根据 KDIGO 标准的 SCr 成分定义。术后无 SCr 的患者假定为无 AKI。新发 CKD 定义为 90 天持续估计肾小球滤过率（eGFR）<60 mL/min/1.73 m2，CKD 进展定义为至少持续 90 天的 1 个阶段恶化。
在 13561 例患者中发现 231 例（1.7%）发生 AKI。造影剂剂量与基础肾功能之间存在交互作用，仅在基础 eGFR<45 mL/min/1.73 m2 的患者中，剂量>150 mL 时 AKI 风险才有统计学意义（OR 5.3，95%CI 2.1-14.2）。AKI 患者的短期和长期生存率较差，新发 CKD（HR 3.7，95%CI 2.7-5.0）和基础 CKD 进展（HR 2.0，95%CI 1.5-2.6）的发生风险均高于中位随访 3.3 年（0.1-8.4 年）的倾向评分匹配对照组。
对于等渗造影剂，基础 eGFR<45 mL/min/1.73 m2 的患者中，造影剂剂量与 AKI 风险呈正相关，且与造影剂剂量相关的 AKI 风险与造影剂剂量呈正相关。除与不良短期和长期生存相关外，AKI 与新发或进展性 CKD 也密切相关，当患者进行纵向随访时。
