Korean J Nephrol.  2008 May;27(3):327-332.

The Clinical Outcome of Acute Renal Failure Requiring Hemodialysis after Coronary Intervention in Patients with Chronic Kidney Disease

• Lim YH
• Jung HW
• Lee YJ
• Kang NR
• Lee JE
• Huh W
• Oh HY
• Kim YG
• Kim DJ

Abstract

PURPOSE
Acute renal failure requiring dialysis (ARFD) after coronary intervention is a rare but serious complication, and it is associated with poor prognosis. This study investigated the clinical characteristics and risk factors of ARFD after coronary intervention in patients with chronic kidney disease (CKD).
METHODS
This study included 178 adult patients with CKD (baseline serum creatinine of >1.3 mg/dL) undergoing coronary intervention at Samsung Medical Center from April 2003 through June 2007. We retrospectively evaluated the incidence, clinical outcome, and risk factor of ARFD via medical records. ARFD was defined as a decrease in renal function necessitating hemodialysis in the first 7 days after percutaneous coronary intervention. The estimated glomerular filtration rate (eGFR) was obtained using the Levey Modification of Diet in Renal Disease (MDRD) formula.
RESULTS
Ten of the 178 patients (5.6%) developed ARFD with a subsequent in-hospital mortality rate of 10% (n=1). According to CKD stage, incidence of ARFD was 0/136 patients (baseline eGFR 30 to 90 ml/min/1.73m2 4/32 (15 to 29,) and 7/10 (<15) respectively (0% vs 9.4% vs 70%, p<0.0001). Multivariate analysis found eGFR (OR=0.5, 95% CI 0.3 to 0.9, p=0.02) to be only independent predictor of ARFD. Of those who developed ARFD (n=10), 2 patients stopped dialysis, 8 had required permanent dialysis.
CONCLUSION
Incidence of ARFD increased according to the severity of renal dysfunction. The majority of ARFD patients had required permanent dialysis.

Keyword

Coronary angiography; Contrast media; Acute renal failure; Dialysis

MeSH Terms

Acute Kidney Injury
Adult
Contrast Media
Coronary Angiography
Creatinine
Dialysis
Diet
Glomerular Filtration Rate
Hospital Mortality
Humans
Incidence
Medical Records
Multivariate Analysis
Percutaneous Coronary Intervention
Prognosis
Renal Dialysis
Renal Insufficiency, Chronic
Retrospective Studies
Risk Factors
Contrast Media
Creatinine