Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
Ren Fail. 2023 Dec;45(1):2195950. doi: 10.1080/0886022X.2023.2195950.
Acute kidney injury (AKI) occurred in 12.8% of patients undergoing surgery and is associated with increased mortality. Chronic kidney disease (CKD) is a well-known risk for death and cardiovascular disease (CVD). Effects of AKI and CKD on patients undergoing coronary angiography (CAG) remain incompletely defined. The aim of our study was to investigate the relationship between acute and CKD and mortality in patients undergoing CAG. The cohort study included 49,194 patients in the multicenter cohort from January 2007 to December 2018. Cox regression analyses and Fine-Gray proportional subdistribution risk regression analysis are used to examine the association between kidney disease and all-cause and cardiovascular mortality. In the present study, 13,989 (28.4%) patients had kidney disease. During follow-up, 6144 patients died, of which 4508 (73.4%) were due to CVD. AKI without CKD (HR: 1.54, 95% CI: 1.36-1.74), CKD without AKI (HR: 2.02, 95% CI: 1.88-2.17), AKI with CKD (HR: 3.26, 95% CI: 2.90-3.66), and end-stage kidney disease (ESKD; HR: 5.63, 95% CI: 4.40-7.20) were significantly associated with all-cause mortality. Adjusted HR (95% CIs) for cardiovascular mortality was significantly elevated among patients with AKI without CKD (1.78 [1.54-2.06]), CKD without AKI (2.28 [2.09-2.49]), AKI with CKD (3.99 [3.47-4.59]), and ESKD (6.46 [4.93-8.46]). In conclusion, this study shows that acute or CKD is present in up to one-third of patients undergoing CAG and is associated with a substantially increased mortality. These findings highlight the importance of perioperative management of kidney function, especially in patients with CKD.Impact Statement Acute kidney injury (AKI) occurred in 12.8% of patients undergoing surgery and is linked to a 22.2% increase in mortality. Chronic kidney disease (CKD) is a well-known risk for death and cardiovascular events. Effects of AKI and CKD on patients undergoing coronary angiography (CAG) remain incompletely defined. This study shows that kidney disease is present in up to one-third of patients undergoing CAG and is associated with a substantially increased mortality. AKI and CKD are independent predicators for mortality in patients undergoing CAG. These findings highlight the importance of perioperative management of kidney function, especially in patients with CKD.
急性肾损伤（AKI）在接受手术的患者中发生率为 12.8%，与死亡率升高相关。慢性肾脏病（CKD）是死亡和心血管疾病（CVD）的已知危险因素。AKI 和 CKD 对接受冠状动脉造影（CAG）的患者的影响仍不完全明确。本研究旨在探讨 AKI 和 CKD 与接受 CAG 患者的死亡率之间的关系。这项多中心队列研究纳入了 2007 年 1 月至 2018 年 12 月期间的 49194 例患者。Cox 回归分析和 Fine-Gray 比例亚分布风险回归分析用于检查肾脏疾病与全因和心血管死亡率之间的关联。在本研究中，13989 例（28.4%）患者患有肾脏疾病。在随访期间，6144 例患者死亡，其中 4508 例（73.4%）死于 CVD。无 CKD 的 AKI（HR：1.54，95%CI：1.36-1.74）、无 AKI 的 CKD（HR：2.02，95%CI：1.88-2.17）、AKI 伴 CKD（HR：3.26，95%CI：2.90-3.66）和终末期肾病（ESKD；HR：5.63，95%CI：4.40-7.20）与全因死亡率显著相关。调整后的心血管死亡率 HR（95%CI）在无 CKD 的 AKI（1.78[1.54-2.06]）、无 AKI 的 CKD（2.28[2.09-2.49]）、AKI 伴 CKD（3.99[3.47-4.59]）和 ESKD（6.46[4.93-8.46]）患者中显著升高。总之，本研究表明，急性或 CKD 存在于多达三分之一的接受 CAG 的患者中，并与死亡率显著增加相关。这些发现强调了围手术期肾功能管理的重要性，特别是在 CKD 患者中。
