Cardiology Division, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Cardiology Division, Massachusetts General Hospital, Boston, MA.
Am Heart J. 2019 Mar;209:36-46. doi: 10.1016/j.ahj.2018.12.001. Epub 2018 Dec 7.
Kidney injury is common in patients with cardiovascular disease.
We determined whether blood measurement of kidney injury molecule-1 (KIM-1), would predict kidney outcomes in patients undergoing angiographic procedures for various indications.
One thousand two hundred eight patients undergoing coronary and/or peripheral angiography were prospectively enrolled; blood was collected for KIM-1 measurement. Peri-procedural acute kidney injury (AKI) was defined as AKI within 48 hours of contrast exposure. Non-procedural AKI was defined as AKI beyond 48 hours. Development of chronic kidney disease (CKD) was defined as progression to an estimated glomerular filtration rate (eGFR) <60 milliliters/minute/1.73 m by study conclusion. Univariate and multivariable Cox proportional hazards models were used to identify predictors of non-procedural AKI, while univariate and multivariable logistic regression analysis was used to evaluate peri-procedural AKI and predictors of progression to CKD.
During mean follow up of 4 years, peri-procedural AKI occurred in 5.0%, non-procedural AKI in 27.3%, and 12.4% developed new reduction in eGFR <60 mL/min/1.73 m2. Higher KIM-1 concentrations were associated with prevalent comorbidities associated with risk in cardiovascular disease and worse left ventricular function. In adjusted analyses, elevated pre- and post-procedural KIM-1 concentrations predicted not only peri-procedural AKI (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.09-2·18, P = .01 and OR 1.54, 95% CI 1.10-2.15, P = .01, respectively) and non-procedural AKI (hazard ratio [HR] 1·49, 95% CI 1·24-1·78, P < .001 and HR 1.46, 95% CI 1.23-1.74, P < .001, respectively), but also progression to CKD (OR 1.99, 95% CI 1.32-2.99, P = .001 and OR 2·02, 95% CI 1·35-3·03, P = .001, respectively).
In a typical at-risk population undergoing coronary and/or peripheral angiography, blood concentrations of KIM-1 may predict incident peri-procedural and non-procedural AKI, as well as progression to CKD.
肾脏损伤在心血管疾病患者中很常见。
我们旨在确定血中肾损伤分子-1（KIM-1）的水平是否可以预测接受各种适应证血管造影术的患者的肾脏结局。
前瞻性纳入 1208 例接受冠状动脉和/或外周血管造影术的患者；采集血样以测量 KIM-1。围手术期急性肾损伤（AKI）定义为造影剂暴露后 48 小时内发生 AKI。非手术性 AKI 定义为造影剂暴露后 48 小时以上发生 AKI。慢性肾脏病（CKD）的发展定义为研究结束时估算肾小球滤过率（eGFR）降至<60 毫升/分钟/1.73 米以下。使用单变量和多变量 Cox 比例风险模型确定非手术性 AKI 的预测因素，而使用单变量和多变量逻辑回归分析评估围手术期 AKI 和进展为 CKD 的预测因素。
在平均 4 年的随访期间，围手术期 AKI 发生率为 5.0%，非手术性 AKI 发生率为 27.3%，12.4%的患者出现新的 eGFR<60 mL/min/1.73 m2下降。较高的 KIM-1 浓度与心血管疾病风险相关的常见合并症和较差的左心室功能相关。在调整分析中，术前和术后升高的 KIM-1 浓度不仅预测了围手术期 AKI（比值比[OR] 1.54，95%置信区间[CI] 1.09-2.18，P=0.01 和 OR 1.54，95% CI 1.10-2.15，P=0.01）和非手术性 AKI（风险比[HR] 1.49，95% CI 1.24-1.78，P<0.001 和 HR 1.46，95% CI 1.23-1.74，P<0.001），而且还预测了 CKD 的进展（OR 1.99，95% CI 1.32-2.99，P=0.001 和 OR 2.02，95% CI 1.35-3.03，P=0.001）。
在接受冠状动脉和/或外周血管造影术的典型高危人群中，KIM-1 的血浓度可能预测围手术期和非手术性 AKI 的发生，以及 CKD 的进展。
