Acute Kidney Injury After Cardiac Revascularization on the Rise
From 2004 to 2012, the incidence of AKI increased from 4.9% to 14.2% among CABG patients and from 2.7% to 8.8% among PCI patients.
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NEW ORLEANS—Acute kidney injury (AKI) following coronary revascularization procedures is increasing in incidence, according to study findings presented at the American Society of Nephrology's Kidney Week 2017.
The study also showed that coronary artery bypass grafting (CABG) was associated with an increased likelihood of post-procedure AKI compared with percutaneous coronary intervention (PCI).
Using the National Inpatient Sample, Siddartha Bhandary, MBBS, MPH, of Providence Hospital in Derwood, Maryland, and colleagues studied a cohort of 274,464 hospitalized patients who had a first-time CABG or PCI for multi-vessel disease from 2004 to 2012. The CABG and PCI patients were propensity score matched for age, sex, race, cardiovascular conditions such as prior myocardial infarction, unstable angina, and heart failure, and co-morbidities such as a hypertension, dyslipidemia, and chronic kidney disease.
From 2004 to 2012, the incidence of AKI rose from 4.9% to 14.2% among CABG patients and from 2.7% to 8.8% among PCI patients. Compared with PCI, CABG was associated with a significantly higher incidence of AKI in each year during the study period. Although patients undergoing CABG had a greater likelihood of post-procedure AKI than those undergoing PCI during the study period, the odds of AKI developing after CABG versus PCI have been declining since 2006. Compared with PCI, CABG was associated with 3.3-fold increased odds of AKI in 2006, 2.7 and 1.7-fold increased odds in 2012.
The investigators do not know why the risk of AKI with CABG versus PCI is declining, but Dr Bhandary said a possible explanation is increased use of off-pump CABG procedures, which might be safer for the kidneys. Another possibility is that surgeons performing CABG procedures with less contrast media, which is associated with kidney injury.
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Shen W, Bhandary S, Jaeil A. Temporal trends in the incidence of AKI after coronary revascularization in a nationwide study. Presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31 to Nov. 5). Abstract SA-PO002.