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Angiography and Contrast-Associated Kidney Injury
Study Questions:
What are the risks and incidence of developing serious adverse outcomes following contrast-associated acute kidney injury (CA-AKI), and does CA-AKI mediate the association of pre-angiography estimated glomerular filtration rate with adverse outcomes?
Methods:
This was a secondary analysis of 4,418 participants enrolled in the PRESERVE (Prevention of Serious Adverse Outcomes Following Angiography) trial. Authors assessed whether CA-AKI (defined as an increase in serum creatinine of ≥0.5 mg/dl and/or ≥25% on day 3-5 assessment compared to pre-angiography level) was associated with the 90-day outcome comprising death, need for dialysis, or persistent impairment in kidney function. In addition, they calculated the incidence of clinically significant CA-AKI (i.e., proportion of patients who developed CA-AKI and the 90-day outcome) and examined whether CA-AKI was a mediator of the association of baseline kidney function with the 90-day outcome.
Results:
CA-AKI was associated with an increased relative risk for 90-day death, need for dialysis, or persistent kidney impairment (odds ratio, 3.93; 95% confidence interval, 2.82-5.49; p < 0.0001). The incidence of clinically significant CA-AKI was 1.2% (53 of 4,418 patients). CA-AKI was not a mediator of the association of pre-angiography estimated glomerular filtration rate with the primary outcome.
Conclusions:
Whereas CA-AKI is associated with an increased relative risk of serious adverse 90-day outcomes, the incidence of clinically significant CA-AKI is very low. CA-AKI does not mediate the association of the pre-angiography estimated glomerular filtration rate with these outcomes.
Perspective:
Findings show that overall rate of CA-AKI after angiography from this large cohort of elective patients with chronic renal insufficiency is low (1.2%) and confirm that development of CA-AKI is associated but not causal with increased risk of adverse clinical outcomes. Using novel statistical methods to perform mediation analyses, the authors were able to show that CA-AKI appears to be a marker of a high-risk patient and does not appear to directly mediate adverse clinical outcomes. Further study needs to validate these findings, especially use of mediation analysis to differentiate association from causation. Findings are a reminder of the need for more comprehensive risk/benefit analysis of angiographic procedures among patients with chronic kidney disease.
Clinical Topics: Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Acute Kidney Injury, Angiography, Contrast Media, Creatinine, Diagnostic Imaging, Dialysis, Glomerular Filtration Rate, Metabolic Syndrome, Renal Dialysis, Renal Insufficiency, Chronic, Risk, Secondary Prevention
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