Skip to main content

Advertisement

SpringerLink
Log in

Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention

  • Original Article
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

Acute kidney injury (AKI) following acute ST elevation myocardial infarction (STEMI) is associated with adverse outcomes. The recently proposed KDIGO criteria suggested modifications to the consensus classification system for AKI, namely lowering the threshold of increase in absolute serum creatinine and extending the time frame for AKI detection to 7 days. We evaluated the incidence, risk factors, and long-term mortality associated with AKI as classified by the KDIGO definition in a large single center cohort of consecutive STEMI patients.

Methods

We retrospectively studied 2122 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI). Recruited patients were admitted between January 2008 and May 2016 to the cardiac intensive care unit with the diagnosis of acute STEMI. We compared the utilization of the KDIGO and consensus criteria for the diagnosis of AKI and its relation to long term mortality.

Results

The KDIGO criteria allowed the identification of more patients as having AKI (10.6 vs. 5.6%, p < 0.001) compared to the consensus criteria. Even mild elevation of serum creatinine (≥ 0.3 mg/dL) was associated with a marked increase in all-cause mortality (HR 4.7, 95% CI 3.1–6.43, p < 0.001). Patients with AKI whose renal function resolved prior to hospital discharge still had significantly higher mortality compared to patients with no AKI (23 vs. 8%, HR 3.1, 95% CI 2.09–4.90, p < 0.001).

Conclusion

KDIGO criteria is more sensitive than the consensus criteria in defining AKI in STEMI patients and identifying populations at risk for long term adverse outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Shacham Y, Steinvil A, Arbel Y (2016) Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity. J nephrol 29:169–174

    Article  PubMed  Google Scholar 

  2. Watabe H, Sato A, Hoshi T et al (2014) Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention. Int J Cardiol 174:57–63

    Article  PubMed  Google Scholar 

  3. Shacham Y, Leshem-Rubinow E, Gal-Oz A et al (2014) Relation of time to coronary reperfusion and the development of acute kidney injury after ST-segment elevation myocardial infarction. Am J Cardiol 114:1131–1135

    Article  PubMed  Google Scholar 

  4. Marenzi G, Cosentino N, Guastoni C (2015) How to balance risks and benefits in the management of CKD patients with coronary artery disease. J Nephrol 114:1131–1135

    Google Scholar 

  5. Solomon R, Dauerman HL (2010) Contrast-induced acute kidney injury. Circulation 122:2451–2455

    Article  PubMed  Google Scholar 

  6. Bellomo R, Ronco C, Kellum JA et al (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mehta RL, Kellum JA, Shah SV et al (2007))Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31

    Article  PubMed  PubMed Central  Google Scholar 

  8. Narula A, Mehran R, Weisz G et al (2014) Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 35:1533–1540

    Article  CAS  PubMed  Google Scholar 

  9. Centola M, Lucreziotti S, Salerno-Uriarte D et al (2016) A comparison between two different definitions of contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int J Cardiol 210:4–9

    Article  PubMed  Google Scholar 

  10. Shacham Y, Leshem-Rubinow E, Ziv-Baran T et al (2014) Incidence and mortality of acute kidney injury in acute myocardial infarction patients: a comparison between AKIN and RIFLE criteria. Int Urol Nephrol 46:2371–2377

    Article  CAS  PubMed  Google Scholar 

  11. Queiroz RE, de Oliveira LS, de Albuquerque CA et al (2012) Acute kidney injury risk in patients with ST-segment elevation myocardial infarction at presentation to the ED. Am J Emerg Med 30:1921–1927

    Article  PubMed  Google Scholar 

  12. Anzai A, Anzai T, Naito K et al (2010) Prognostic significance of acute kidney injury after reperfused ST-elevation myocardial infarction: synergistic acceleration of renal dysfunction and left ventricular remodeling. J Card Fail 16:381–389

    Article  PubMed  Google Scholar 

  13. Acute Kidney Injury Work Group Kidney Disease (2012) Improving global outcomes (KDIGO)—clinical practice guideline for acute kidney injury. Kidney Inter suppl 2:1–138

    Article  Google Scholar 

  14. O’Gara PT, Kushner FG, Ascheim DD et al (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 61:e78–e140

    Article  PubMed  Google Scholar 

  15. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 130:461–470

    Article  CAS  PubMed  Google Scholar 

  16. National kidney foundation (nkf) kidney disease outcome quality initiative (k/doqi) advisory board (2002) Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266

    Google Scholar 

  17. Gurm HS, Dixon SR, Smith DE et al (2011) Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 58:907–914

    Article  PubMed  Google Scholar 

  18. Tehrani S, Laing C, Yellon DM et al (2013) Contrast-induced acute kidney injury following PCI. Eur J Clin Invest 43:483–490

    Article  PubMed  Google Scholar 

  19. James MT, Samuel SM, Manning MA et al (2013) Contrast-induced acute kidney injury and risk of adverse clinical outcomes after coronary angiography: a systematic review and meta-analysis. Circ Cardiovasc interv 6:37–43

    Article  PubMed  Google Scholar 

  20. Mager A, Vaknin Assa H, Lev EI, Bental T, Assali A, Kornowski R (2011) The ratio of contrast volume to glomerular filtration rate predicts outcomes after percutaneous coronary intervention for ST-segment elevation acute myocardial infarction. Catheter Cardiovasc Interv 78:198–201

    Article  PubMed  Google Scholar 

  21. Laskey WK, Jenkins C, Selzer F et al (2007) Volume-to-creatinine clearance ratio: a pharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention. J Am Coll Cardiol 50:584–590

    Article  CAS  PubMed  Google Scholar 

  22. Morabito S, Pistolesi V, Benedetti G et al (2012) Incidence of contrast-induced acute kidney injury associated with diagnostic or interventional coronary angiography. J Nephrol 25:1098–1107

    Article  CAS  PubMed  Google Scholar 

  23. Shacham Y, Leshem-Rubinow E, Gal-Oz A et al (2015) Acute cardio-renal syndrome as a cause for renal deterioration among myocardial infarction patients treated by primary percutaneous intervention. Can J Cardiol 31:1240–1244

    Article  PubMed  Google Scholar 

  24. Mehran R, Aymong ED, Nikolsky E et al (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44:1393–1399

    PubMed  Google Scholar 

  25. Marenzi G, Lauri G, Assanelli E et al (2004) Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 44:1780–1785

    Article  PubMed  Google Scholar 

  26. Zhao JL, Yang YJ, Zhang YH, You SJ, Wu YJ, Gao R (2008) Effect of statins on contrast-induced nephropathy in patients with acute myocardial infarction treated with primary angioplasty. Int J Cardiol 126:435–436

    Article  PubMed  Google Scholar 

  27. Ueda H, Yamada T, Masuda M et al (2011) Prevention of contrast-induced nephropathy by bolus injection of sodium bicarbonate in patients with chronic kidney disease undergoing emergent coronary procedures. Am J Cardiol 107:1163–1167

    Article  CAS  PubMed  Google Scholar 

  28. Gassanov N, Nia AM, Caglayan E, Er F (2014) Remote ischemic preconditioning and renoprotection: from myth to a novel therapeutic option? J Am Soc Nephrol 25:216–224

    Article  CAS  PubMed  Google Scholar 

  29. Hausenloy DJ, Candilio L, Laing C et al (2012) Effect of remote ischemic preconditioning on clinical outcomes in patients undergoing coronary artery bypass graft surgery (ERICCA): rationale and study design of a multi-centre randomized double-blinded controlled clinical trial. Clin Res Cardiol 101:339–348

    Article  CAS  PubMed  Google Scholar 

  30. Botker HE, Kharbanda R, Schmidt MR et al (2010) Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial. Lancet 375:727–734

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel

    Gilad Margolis, Sevan Letourneau-Shesaf, Shafik Khoury, Gad Keren & Yacov Shacham

  2. Department of Nephrology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Amir Gal-Oz

Authors
  1. Gilad Margolis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amir Gal-Oz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sevan Letourneau-Shesaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shafik Khoury
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gad Keren
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yacov Shacham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yacov Shacham.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study protocol was approved by the local institutional ethics committee.

Informed consent

As this was a retrospective data analysis, the local institutional ethics committee waved the need for informed consent (IRB-TLV-16-224).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Margolis, G., Gal-Oz, A., Letourneau-Shesaf, S. et al. Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention. J Nephrol 31, 423–428 (2018). https://doi.org/10.1007/s40620-017-0461-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40620-017-0461-3

Keywords

Search

Navigation