Clinical and Experimental Nephrology

, Volume 23, Issue 2, pp 182–188 | Cite as

Influence of chronic kidney disease and worsening renal function on clinical outcomes in patients undergoing primary percutaneous coronary intervention

  • Toshijiro Aoki
  • Hideki IshiiEmail author
  • Akihito Tanaka
  • Susumu Suzuki
  • Satoshi Ichimiya
  • Masaaki Kanashiro
  • Toyoaki Murohara
Original article



The combined influence of CKD and worsening renal function (WRF) on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been fully understood.


We analyzed 443 patients diagnosed with AMI who underwent primary PCI. Based on their estimated glomerular filtration rate (eGFR), they were classified into two groups: a high eGFR group (eGFR ≥ 45 mL/min/1.73 m2, n = 381) and a low eGFR group (eGFR < 45 mL/min/1.73 m2, n = 63). WRF was defined as an increase in serum creatinine levels ≥ 0.3 mg/dL above the admission value during the course of hospitalization. The primary end-point was set as all-cause mortality.


WRF was observed in 88 patients (19.8%). The median follow-up duration was 769 (interquartile range 397–1314) days. The all-cause mortality rate was significantly lower in the high eGFR than in the low eGFR group (5.5 vs. 28.6%, respectively, at 1500 days, P < 0.001). In patients with WRF, the all-cause and cardiac mortality rates were significantly higher than in patients without WRF, and these results were consistent between the high and low eGFR sub-groups. Multivariate Cox proportional hazards model analysis showed that low eGFR and WRF remained independent predictors of all-cause mortality [(hazard ratio 2.61, 95% confidence interval 1.27–5.36, P = 0.009) and (hazard ratio 2.59, 95% confidence interval 1.34–5.01, P = 0.005), respectively].


Both eGFR at baseline and WRF were observed to be important predictors of mortality in patients with AMI undergoing primary PCI. WRF showed a significant effect on mortality even in patients with high eGFR.


Acute myocardial infarction Chronic kidney disease Worsening renal function Mortality 



This study was supported by Mitsui Life Social Welfare Foundation.

Compliance with ethical standards

Conflict of interest

H.I. received lecture fees from Astellas Pharma Inc., Astrazeneca Inc., Daiichi-Sankyo Pharma Inc. and MSD K.K. T. M. received lecture fees from Bayel Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K.K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi-aventis K.K., and Takeda Pharmaceutical Co., Ltd. T.M.received unrestricted research grant for Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma Inc, Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K.K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Otsuka Pharma Ltd., Pfizer Japan Inc., Sanofi-aventis K.K., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2011-1139 in Nagoya University Hospital and 2010-7 in Yokkaichi Municipal Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Supplementary material

10157_2018_1622_MOESM1_ESM.pptx (169 kb)
Supplemental Figure 1: Kaplan–Meier curves for cardiac mortality rate according to WRF (a) and each eGFR group, high eGFR sub-group (b, solid lines) and low eGFR sub-group (b, dashed lines). WRF, worsening renal function; eGFR, estimated glomerular filtration rate (PPTX 169 KB)
10157_2018_1622_MOESM2_ESM.docx (20 kb)
Supplemental Figure 2: Kaplan–Meier curves for all-cause mortality rate according to each CKD stages. CKD, Chronic kidney disease (DOCX 19 KB)
10157_2018_1622_MOESM3_ESM.pptx (141 kb)
Supplementary material 3 (PPTX 140 KB)


  1. 1.
    Go AS, Chertow MG, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.CrossRefGoogle Scholar
  2. 2.
    AlFaleh HF, Alsuwaida AO, Ullah A, et al. The prognostic impact of in-hospital worsening of renal function in patients with acute coronary syndrome. Int J Cardiol. 2013;167:866–70.CrossRefGoogle Scholar
  3. 3.
    Amin AP, Spertus JA, Reid KJ, et al. The prognostic importance of worsening renal function during an acute myocardial infarction on long-term mortality. Am Heart J. 2010;160:1065–71.CrossRefGoogle Scholar
  4. 4.
    Giacoppo D, Madhavan MV, Baber U, et al. Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes: pooled analysis from the HORIZONS-AMI and ACUITY trials. Circ Cardiovasc Interv. 2015;8:e002475.CrossRefGoogle Scholar
  5. 5.
    Goldstein JA, Maini B, Dixon SR, et al. Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction. Circ Cardiovasc Interv. 2011;4:429–37.CrossRefGoogle Scholar
  6. 6.
    Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.CrossRefGoogle Scholar
  7. 7.
    Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63:713–35.CrossRefGoogle Scholar
  8. 8.
    Levin A, Warnock DG, Mehta RL, et al. Improving outcomes from acute kidney injury: report of an initiative. Am J Kidney Dis. 2007;50:1–4.CrossRefGoogle Scholar
  9. 9.
    Bae EH, Lim SY, Cho KH, et al. GFR and cardiovascular outcomes after acute myocardial infarction: results from the Korea acute myocardial infarction registry. Am J Kidney Dis. 2012;59:795–802.CrossRefGoogle Scholar
  10. 10.
    Hsu CY, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol. 2002;13:504–10.CrossRefGoogle Scholar
  11. 11.
    Raggi P, Boulay A, Chasan-Taber S, et al. Cardiac calcification in adult hemodialysis patients: a link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol. 2002;39:695–701.CrossRefGoogle Scholar
  12. 12.
    Munttner P, Hamm LL, Kusek JW, Chen J, Whelton PK, He J. The prevalence of nontraditional risk factors for coronary heart disease in patients with chronic kidney disease. Ann Intern Med. 2004;140:9–17.CrossRefGoogle Scholar
  13. 13.
    Murata N, Kaneko H, Yajima J, et al. The prognostic impact of worsening renal function in Japanese patients undergoing percutaneous coronary intervention with acute coronary syndrome. J Cardiol. 2015;66:326–32.CrossRefGoogle Scholar
  14. 14.
    Lazaros G, Tsiachris D, Tousoulis D, et al. In-hospital worsening renal function is an independent predictor of one-year mortality in patients with acute myocardial infarction. Int J Cardiol. 2012;155:97–101.CrossRefGoogle Scholar
  15. 15.
    Damman K, Solomon SD, Pfeffer MA, et al. Worsening renal function and outcome in heart failure patients with reduced and preserved ejection fraction and the impact of angiotensin receptor blocker treatment: data from the CHARM-study programme. Eur J Heart Fail. 2016;18:1508–17.CrossRefGoogle Scholar
  16. 16.
    Ferrer-Hita JJ, Dominguez-Rodriguez A, Garcia-Gonzalez MJ, Abreu-Gonzalez PA. Renal dysfunction is an independent predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty. Int J Cardiol. 2007;118:243–5.CrossRefGoogle Scholar
  17. 17.
    Krishnamoorthy A, Greiner MA, Sharma PP, et al. Transient and persistent worsening renal function during hospitalization for acute heart failure. Am Heart J. 2014;168:891–900.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Toshijiro Aoki
    • 1
  • Hideki Ishii
    • 1
    Email author
  • Akihito Tanaka
    • 1
  • Susumu Suzuki
    • 1
  • Satoshi Ichimiya
    • 2
  • Masaaki Kanashiro
    • 2
  • Toyoaki Murohara
    • 1
  1. 1.Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of CardiologyYokkaichi Municipal HospitalYokkaichiJapan

Personalised recommendations