M JIANG1, W KUO1
1Chi Mei Medical Center, Tainan, Taiwan
Aim: We aimed to compare the incidence of acute kidney injury (AKI) after percutaneous coronary intervention (PCI) by different denominators and AKI definitions in a single population.
Background: AKI is a common complication among patients undergoing PCI. Estimated incidence of AKI after PCI varied widely because of diverse AKI definitions, denominators, sample sizes and populations.
Methods: We retrospectively reviewed the medical records of 4,638 patients undergoing PCIs at a tertiary care center. We excluded patients who received dialysis before PCI (467 patients) and those whose baseline serum creatinine were missing (6 patients), contributing to denominator 1 (n=4165 patients). We further excluded 2961 patients whose post-procedural creatinine were unavailable, contributing to denominator 2 (n=1204 patients). AKI was defined as creatinine increases of ≥25% or ≥0.5 mg/dL (contrast-induced nephropathy, CIN), or ≥50% or ≥0.3 mg/dL (acute kidney injury network criteria, AKIN).
Results: By using denominator 1, the AKI incidence was 4.87% (AKIN) and 4.56% (CIN). By using denominator 2, the AKI incidence was 16.78% (AKIN) and 15.78% (CIN). There was a threefold difference of AKI incidence in the same population. Compared with those whose post-PCI creatinine unavailable, patients with post-PCI creatinine data were significantly older (63.25 vs. 68.55 years old, p< 0.001), worse baseline kidney function (estimated glomerular filtration rate 68.95 vs. 50.80 ml/min/1.73m2, p< 0.001), more comorbidities including diabetes, prior PCI, and prior heart failure, more acute myocardial infarction (AMI), and more severe in clinical conditions including acute heart failure and cardiogenic shock.
Conclusions: The AKI incidences may be biased with different denominators. Collecting pre- and post-PCI creatinine in all PCI patients is needed for accurate estimation of AKI incidence.
Dr. Ming-Yan Jiang is a nephrologist with 6-year working experience in nephrology division of Chi Mei Medical Center. He obtained the degree of Doctor of Medicine from Kaohsiung Medical University, Taiwan. He achieved the Master Degree in Public Health from College of Medicine, National Cheng Kung University, Tainan, Taiwan. The research interests include acute kidney injury, chronic kidney disease and end stage renal disease.