Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

doi:10.5847/wjem.j.issn.1920-8642.2012.03.007

Abstract

Abstract:

BACKGROUND: Acute kidney injury following percutaneous coronary intervention (PCI) is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury (AKI) in patients after intracoronary stent implantation are still unknown.

METHODS: A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included: 1) pre-operative ones: age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate (eGFR), hyperuricemia, proteinuria, emergency operation, hydration, medications (ACEI/ARBs, statins); 2) intraoperative ones: dose of contrast media, operative time, hypotension; and 3) postoperative one: hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis.

RESULTS: Of the 325 patients, 51(15.7%) developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters (left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration), emergency operation, intraoperative parameters (operative time, hypotension) and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age (OR=0.253, 95%CI=0.088-0.727), pre-operative proteinuria (OR=5.351, 95%CI=2.128-13.459), pre-operative left ventricular insufficiency (OR=8.704, 95%CI=3.170-23.898), eGFR≤60 ml/min/1.73 m² (OR=6.677, 95%CI=1.167-38.193), prolonged operative time, intraoperative hypotension (OR=25.245, 95%CI=1.001-1.034) were independent risk factors of AKI.

CONCLUSIONS: AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors of AKI.

Key words: Intracoronary stent implantation, Acute kidney injury, Risk factor, Outcome

Fei He, Jun Zhang, Zhong-qiu Lu, Qing-ling Gao, Du-juan Sha, Li-gang Pei, Guo-feng Fan. Risk factors and outcomes of acute kidney injury after intracoronary stent implantation[J]. World Journal of Emergency Medicine, 2012, 3(3): 197-201.

Figures/Tables 2

Table 1

Table 2

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Viariables	AKI group, n=51 (%)	Normal group, n=274 (%)	t/Z	χ²	P
Age (yr)
≥65	37 (72.5 )	143 (52.2 )
<65	14 (27.5 )	131 (47.8 )	—	7.213	<0.01
Gender
Male	37 (72.5 )	190 (69.3 )
Female	14 (27.5 )	84 (30.7 )	—	0.210	>0.05
Hypertension	40 (78.4 )	208 (75.9 )	—	0.151	>0.05
Cerebrovascular disease	8 (16 )	30 (10.9 )	—	0.935	>0.05
Diabetes mellitus	18 (36 )	87 (31.8 )	—	0.247	>0.05
Left ventricular insufficiency	39 (76.5 )	76 (27.7 )	—	44.662	<0.01
Peripheral angiopathy	3 (5.9 )	2 (0.7 )	—	—	0.029^a)
Pre-operative creatinine (μmmol/L)
≤106	35 (68.6 )	9 (3.3 )
>106	16 (31.4 )	265 (96.7 )	—	156.834	<0.01
Pre-operative urea nitrogen (mmol/L)	7.54±3.88	5.81±2.17	-2.763	—	0.006^b)
Pre-operative eGFR (ml/min/1.73m²)
<60	11 (21.6 )	1 (0.4 )		—
≥60	40 (78.4 )	273 (99.6 )	—	48.563	<0.01
Hyperuricemia (mmol/L)	26 (51 )	51 (18.6 )	—	24.916	<0.01
Pre-operative proteinuria	31 (60.8 )	36 (13.2 )	—	59.642	<0.01
Emergency operation	19 (37.3 )	49 (17.9 )	—	9.752	<0.01
Medications
ACEI/ ARBs	39 (76.5 )	188 (68.6 )	—	1.260	>0.05
Statins	46 (90.2 )	262 (95.6 )	—	2.552	>0.05
Pre-operative hydration	34 (66.7 )	241 (88.0 )	—	16.334	<0.01
Dose of contrast media (mL)	152.50±59.98	161.96±65.79	-1.018	—	0.309
Operatioe time (min)	78.22±41.68	68.02±28.75	-2.409	—	0.017
Intraoperative hypotension (mmHg)	12 (23.5 )	5 (1.8 )	—	36.600	<0.01
Postoperative hypotension (mmHg)	4 (7.8 )	3 (1.1 )	—	6.365	0.012

Variables	β	SE	Wald	OR	95%CI	P
Age≥65 years	-1.373	0.538	6.509	0.253	0.088-0.727	0.011
Pre-operative proteinuria	1.677	0.471	12.704	5.351	2.128-13.459	<0.01
Pre-operative left ventricular insufficiency	2.164	0.515	17.631	8.704	3.170-23.898	<0.01
Pre-operative eGFR<60 ml/min/1.73 m²	1.899	0.890	4.553	6.677	1.167-38.193	0.033
Prolonged operative time	0.017	0.008	4.366	1.017	1.001-1.034	0.037
Intraoperative hypotension	3.229	0.862	14.042	25.245	4.664-136.630	<0.01

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