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  • Title: Impact of renal function on patients with acute coronary syndromes: 15,593 patient-years study.
    Author: Kuźma Ł, Małyszko J, Kurasz A, Niwińska MM, Zalewska-Adamiec M, Bachórzewska-Gajewska H, Dobrzycki S.
    Journal: Ren Fail; 2020 Nov; 42(1):881-889. PubMed ID: 32862755.
    Abstract:
    INTRODUCTION: Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. AIM: The aim of our study was to assess renal function impact on mortality among patients with ACS. MATERIALS AND METHODS: The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009-2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m2, hemodialysis. Mean observation time was 2296 days. RESULTS: Criteria were met by 2213 patients. CKD occurred in 24.1% (N = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), p = .006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), p < .001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), p < .001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567-5.721, p < .001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029-4.463, p = .042), atrial fibrillation (RR: 2.289, 95%CI: 1.056-4.959, p = .036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481-3.424, p < .001). CONCLUSION: PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI.
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