Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Clin Cardiol. 2024 Oct;47(10):e70002. doi: 10.1002/clc.70002.
Acute kidney injury (AKI) is a common and serious complication of ST-elevation myocardial infarction (STEMI). AKI and chronic kidney disease (CKD) are highly heterogeneous, leaving a wide gap between them. Therefore, the term acute kidney disease (AKD) was implemented, describing prolonged renal injury between 7 and 90 days. We aimed to evaluate the prevalence and predictors of AKD among STEMI patients.
This retrospective observational study included 2940 consecutive patients admitted with STEMI between 2008 and 2022. Renal function was assessed upon admission and routinely thereafter. Renal outcomes were evaluated according to KDIGO criteria, with AKD defined as persistent renal injury of between 7 and 90 days.
Two hundred and fifty-two subjects with STEMI and AKI were included; of them, 117 (46%) developed AKD. Among baseline CKD patients, higher rates of AKD were observed (60% vs. 46%). KDIGO index ≥ 2 was an independent predictor for AKD in in subjects without baseline CKD (AOR 2.63, 95% CI 1.07-6.53). In subjects with baseline CKD, older age and higher creatinine were independent predictors for AKD. Subjects with AKD had a higher 1-year mortality rate (HR 3.39, 95% CI 1.71-6.72, p < 0.01). This trend was mainly driven by the CKD subpopulation where higher mortality rates for AKD on CKD were observed (HR 5.26, 95% CI 1.83-15.1, p < 0.01).
AKD is common among STEMI patients with AKI. The presence of CKD and higher KDIGO stage should prompt strict monitoring for early diagnosis, treatment, and prevention of renal function deterioration.
急性肾损伤（AKI）是 ST 段抬高型心肌梗死（STEMI）的常见且严重的并发症。AKI 和慢性肾脏病（CKD）高度异质，两者之间存在很大差距。因此，提出了急性肾疾病（AKD）的概念，描述了 7 至 90 天之间的持续性肾损伤。我们旨在评估 STEMI 患者中 AKD 的患病率和预测因素。
这是一项回顾性观察性研究，纳入了 2008 年至 2022 年间连续收治的 2940 例 STEMI 患者。入院时及随后常规评估肾功能。根据 KDIGO 标准评估肾脏结局，将 AKD 定义为 7 至 90 天之间的持续性肾损伤。
纳入了 252 例 STEMI 合并 AKI 的患者，其中 117 例（46%）发生了 AKD。在基线 CKD 患者中，AKD 发生率更高（60%比 46%）。在无基线 CKD 的患者中，KDIGO 指数≥2 是 AKD 的独立预测因素（AOR 2.63，95%CI 1.07-6.53）。在基线 CKD 患者中，年龄较大和肌酐较高是 AKD 的独立预测因素。AKD 患者的 1 年死亡率较高（HR 3.39，95%CI 1.71-6.72，p<0.01）。这种趋势主要是由 CKD 亚组驱动的，在该亚组中，AKD 患者的 CKD 死亡率更高（HR 5.26，95%CI 1.83-15.1，p<0.01）。
AKD 在 STEMI 合并 AKI 的患者中很常见。CKD 的存在和较高的 KDIGO 分期应促使进行严格监测，以便早期诊断、治疗和预防肾功能恶化。
