Int J Heart Fail.
2019 Oct;1(1):72-85. 10.36628/ijhf.2019.0006.
Incidence, Risk Factors and Prognosis of Contrast-Induced Acute Kidney Injury in Acute Heart Failure Patients Undergoing Coronary Angiography
- Park J
1 - Mebazaa A2
- Park JJ3
- Rhee Tm4
- Park HA5
- Lee GY6
- Choi JO6
- Jeon ES6
- Lee SE7
- Cho HJ4
- Lee HY4
- Oh BH8
- Choi DJ3
- on behalf of the Korean Acute Heart Failure (KorAHF) Investigators
- Affiliations
-
- 1Northwestern Medicine Developmental Therapeutics Institute, Chicago, IL, USA
- 2Department of Anesthesiology and Intensive Care Medicine, Saint Louis-Lariboisière University Hospitals, University Paris Diderot, Paris, France
- 3Cardiovascular Center & Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 4Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 5Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
- 6Department of Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
- 7Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 8Mediplex Sejong Hospital, Incheon, Korea
- KMID: 2532595
- DOI: http://doi.org/10.36628/ijhf.2019.0006
Abstract
- Background and Objectives
Heart failure (HF) is a well-known risk factor for contrastinduced acute kidney injury (CI-AKI). We sought to evaluate the risk factors and prognostic impact of CI-AKI in patients with AHF who undergo coronary angiography (CAG).
Methods
A total 594 patients with AHF underwent CAG from May 1, 2011 to December 31, 2013. CI-AKI was defined as an increase ≥25% or ≥0.5 mg/dL in serum creatinine at 48 hours after CAG or the initiation of dialysis after CAG. The deviation of body weight on CAG day from the dry weight (ΔBWTCAG, %) was calculated for each patient.
Results
Overall, CI-AKI was observed in 24.7% of patients. Patients with CI-AKI had higher in-hospital death (16.3% vs. 5.1%, p<0.001; relative risk [RR], 2.50; 95% confidence interval [CI], 1.45–4.31) and 1-year post-discharge death (38.1% vs. 17.4%, p<0.001; hazard ratio, 2.16; 95% CI, 1.40–3.34) than those without CI-AKI. Patients with CI-AKI had greater ΔBWTCAG than those without CI-AKI (5.5±5.7% vs. 3.7±4.0%, p<0.001). A J-shaped association between the risk of CI-AKI and ΔBWTCAG was noted. In patients with weight excess (n=179), an increase of ΔBWT by 1% was associated with 9% (RR, 1.09; 95% CI, 1.03–1.16), while in patients with weight deficiency (n=86), a decrease of ΔBWT by 1% was associated with 11% increased risk for CI-AKI (RR, 1.11; 95% CI, 1.05–1.17).
Conclusions
In AHF patients undergoing CAG CI-AKI is common and associated with worse clinical outcomes. Achieving optimum body weight before CAG may reduce the risk of CI-AKI.
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