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Association of decreasing hemoglobin levels with the incidence of acute kidney injury after percutaneous coronary intervention: a prospective multi-center study

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Abstract

Acute kidney injury (AKI) is common in patients undergoing percutaneous coronary intervention (PCI). One risk factor for AKI is periprocedural hemoglobin drop level (> 3 g/dL); however, whether the relationship between hemoglobin drop and AKI is linear or nonlinear remains unknown. We aimed to investigate the relationship between periprocedural hemoglobin drop and AKI after PCI. We evaluated 14,273 consecutive patients undergoing PCI between September 2008 and March 2019. AKI was defined as an absolute or a relative increase in serum creatinine level of 0.3 mg/dL or 50%, respectively. Restricted cubic spline was constructed to assess the association between hemoglobin drop and AKI by logistic regression and machine learning (ML) models, which were used to predict the risk of AKI. The patients’ mean age was 68.4 ± 11.6 years; the AKI incidence was 10.5% (N = 1499). An absolute > 3 g/dL or 20% relative decrease in hemoglobin level was an independent predictor of AKI incidence (odds ratio, OR [95% confidence interval, CI]: 2.24 [1.92–2.61], P < 0.001; 2.35 [2.04–2.71], P < 0.001, respectively). An adjusted restricted cubic spline demonstrated that absolute/relative decrease in hemoglobin was linearly associated with AKI. Logistic and ML models with absolute/relative hemoglobin changes were comparable while estimating the risk of AKI (absolute area under the curve [AUC] (logistic):0.826, AUC (ML): 0.820; relative AUC (logistic): 0.818, AUC (ML): 0.816). An absolute/relative decrease in periprocedural hemoglobin after PCI was linearly associated with AKI. Detection of a relative/absolute decrease in hemoglobin may help clinicians identify individuals as high risk for AKI after PCI.

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Acknowledgment

The authors thank all the investigators, clinical coordinators, and institutions involved in the JCD- KiCS. Investigators Yohei Numasawa, Masaki Kodaira (Japanese Red Cross Ashikaga Hospital), Yutaka Okada (Eiju General Hospital), Soushin Inoue, Iwao Nakamura (Hino Municipal Hospital), Takaharu Katayama, Shunsuke Takagi, Takashi Matsubara (Hiratsuka City Hospital), Masashi Takahashi, Keishu Li, Koichiro Sueyoshi (Kawasaki City Municipal Hospital), Taku Inohara, Fumiaki Yashima, Atsushi Anzai, Kentaro Hayashida, Takashi Kawakami, Hideaki Kanazawa, Shunsuke Yuasa, Yuichiro Maekawa (Keio University School of Medicine), Masahiro Suzuki, Keisuke Matsumura (National Hospital Organization Saitama National Hospital) Yukinori Ikegami, Jun Fuse, Munehisa Sakamoto, Yukihiko Momiyama (National Hospital Organization Tokyo Medical Center), Ayaka Endo, Tasuku Hasegawa, Toshiyuki Takahashi, Susumu Nakagawa (Saiseikai Central Hospital), Takashi Yagi, Koji Ueno, Kenichiro Shimoji, Shigetaka Noma (Saiseikai Utsunomiya Hospital), Masahito Munakata, Takashi Akima, Shiro Ishikawa, Takashi Koyama (Saitama City Hospital), Atsushi Mizuno, Yutaro Nishi (St Luke’s International Hospital Heart Center), Toshimi Kageyama, Kazunori Moritani, Masaru Shibata (Tachikawa Kyosai Hospital), Kimi Koide, Yoshinori Mano, Takahiro Oki (Tokyo Dental College Ichikawa General Hospital), Daisuke Shinmura, Koji Negishi, Yusuke Jo, and Takahiro Koura (Yokohama Municipal Hospital). Clinical Coordinators Junko Susa, Ayano Amagawa, Hiroaki Nagayama, Miho Umemura, Itsuka Saito, and Ikuko Ueda.

Funding

This research study was supported by a grant from the Ministry of Education, Culture, Sports, Science, and Technology, Japan (KAKENHI No. 25460630 and No. 25460777). Grant-in-Aid from the Japanese Ministry of Health, Labor and Welfare (No. H29-Refractory Disease-034).

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Authors and Affiliations

  1. Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th street, New York, NY, 10003, USA

    Toshiki Kuno, Takahisa Mikami & Masaki Kodaira

  2. Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan

    Yohei Numasawa

  3. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

    Nozomi Niimi, Mitsuaki Sawano, Ikuko Ueda, Keiichi Fukuda & Shun Kohsaka

  4. Department of Cardiology, Saitama National Hospital, Wako, Japan

    Masahiro Suzuki

  5. Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan

    Koji Ueno

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  1. Toshiki Kuno
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  2. Yohei Numasawa
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  3. Takahisa Mikami
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  4. Nozomi Niimi
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  5. Mitsuaki Sawano
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  7. Masahiro Suzuki
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  8. Koji Ueno
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  9. Ikuko Ueda
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  10. Keiichi Fukuda
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  11. Shun Kohsaka
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Corresponding author

Correspondence to Toshiki Kuno.

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Conflict of interest

Dr. Kohsaka received a research grant for the Department of Cardiology, Keio University School of Medicine from Bayer Pharmaceutical Co., Ltd and Daiichi Sankyo Co., Ltd. but the funder did not have any role in the study design, data collection, data analysis, decision to publish, or manuscript preparation. All the authors have no conflicts of interest to disclose.

Ethical approval and IRB Information

The present study was approved by the IRB Committee of Keio University (Reference Number: 20080073).

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Kuno, T., Numasawa, Y., Mikami, T. et al. Association of decreasing hemoglobin levels with the incidence of acute kidney injury after percutaneous coronary intervention: a prospective multi-center study. Heart Vessels 36, 330–336 (2021). https://doi.org/10.1007/s00380-020-01706-w

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  • DOI: https://doi.org/10.1007/s00380-020-01706-w

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