Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
J Am Soc Nephrol. 2021 Mar;32(3):654-662. doi: 10.1681/ASN.2020040502. Epub 2020 Dec 18.
Undergoing percutaneous coronary intervention (PCI) is a risk factor for AKI development, but few studies have quantified racial differences in AKI incidence after this procedure.
We examined the association of self-reported race (Black, White, or other) and baseline eGFR with AKI incidence among patients who underwent PCI at Duke University Medical Center between January 1, 2003, and December 31, 2013. We defined AKI as a 0.3 mg/dl absolute increase in serum creatinine within 48 hours, or ≥1.5-fold relative elevation within 7 days post-PCI from the reference value ascertained within 30 days before PCI.
Of 9422 patients in the analytic cohort (median age 63 years; 33% female; 75% White, 20% Black, 5% other race), 9% developed AKI overall (14% of Black, 8% of White, 10% of others). After adjustment for demographics, socioeconomic status, comorbidities, predisposing medications, PCI indication, periprocedural AKI prophylaxis, and PCI procedural characteristics, Black race was associated with increased odds for incident AKI compared with White race (odds ratio [OR], 1.79; 95% confidence interval [95% CI], 1.48 to 2.15). Compared with Whites, odds for incident AKI were not significantly higher in other patients (OR, 1.30; 95% CI, 0.93 to 1.83). Low baseline eGFR was associated with graded, higher odds of AKI incidence ( value for trend <0.001); however, there was no interaction between race and baseline eGFR on odds for incident AKI ( value for interaction = 0.75).
Black patients had greater odds of developing AKI after PCI compared with White patients. Future investigations should identify factors, including multiple domains of social determinants, that predispose Black individuals to disparate AKI risk after PCI.
经皮冠状动脉介入治疗（PCI）是急性肾损伤（AKI）发展的一个风险因素，但很少有研究量化了该手术后 AKI 发生率的种族差异。
我们研究了在杜克大学医学中心接受 PCI 的患者中，自我报告的种族（黑人、白人或其他）和基线估计肾小球滤过率（eGFR）与 AKI 发生率之间的关联。我们将 AKI 定义为术后 48 小时内血清肌酐绝对值增加 0.3mg/dl，或术后 7 天内相对升高 1.5 倍以上，与 PCI 前 30 天内确定的参考值相比。
在分析队列的 9422 名患者中（中位年龄 63 岁；33%为女性；75%为白人，20%为黑人，5%为其他种族），总体有 9%发生 AKI（黑人占 14%，白人占 8%，其他人占 10%）。在校正了人口统计学、社会经济状况、合并症、易患药物、PCI 适应证、围手术期 AKI 预防以及 PCI 手术特征后，与白人相比，黑人种族发生 AKI 的几率更高（比值比[OR]，1.79；95%置信区间[95%CI]，1.48 至 2.15）。与白人相比，其他种族患者发生 AKI 的几率没有显著增加（OR，1.30；95%CI，0.93 至 1.83）。低基线 eGFR 与 AKI 发生率呈分级、更高的几率相关（趋势值<0.001）；然而，种族和基线 eGFR 之间对 AKI 发生率的交互作用没有显著差异（交互作用值=0.75）。
与白人患者相比，黑人患者在 PCI 后发生 AKI 的几率更高。未来的研究应该确定包括社会决定因素多个领域的因素，这些因素使黑人个体在 PCI 后 AKI 的风险不同。
