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. 2019 Jul 20;132(14):1660-1665.
doi: 10.1097/CM9.0000000000000293.

Risk factors for acute kidney injury in patients with acute myocardial infarction

Cong Wang  1 , Yuan-Yuan Pei  2 , Yun-Hui Ma  2 , Xiao-Lu Ma  2 , Zhi-Wei Liu  3 , Ji-Hong Zhu  2 , Chun-Sheng Li  1
Affiliations

Risk factors for acute kidney injury in patients with acute myocardial infarction

Cong Wang et al. Chin Med J (Engl). .

Abstract

Background: Acute kidney injury (AKI) is a serious and fatal complication of acute myocardial infarction (AMI). It has high short- and long-term mortality rates and a poor prognosis but is potentially preventable. However, the current incidence, risk factors, and outcomes of AKI in the Chinese population are not well understood and would serve the first step to identify high-risk patients who could receive preventative care.

Methods: The medical data of 1124 hospitalized patients diagnosed with AMI from October 2013 to September 2015 were reviewed. AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes criteria. All the patients were divided into either the AKI group or the non-AKI group. A univariate comparison analysis was performed to identify possible risk factors associated with AKI. A multiple logistic regression analysis was used to identify the independent risk factors for AKI in patients with AMI.

Results: Overall, the incidence of AKI was 26.0%. The mortality rate of the AKI group was 20.5%, and the mortality rate of the non-AKI group was 0.6% (P < 0.001). Logistic regression analysis showed that the independent risk factors for AKI in patients with AMI included: age (>60 years old) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.05, P = 0.000), hypertension (OR 2.51, 95% CI 1.62-3.87, P = 0.000), chronic kidney disease (OR 3.52, 95% CI 2.01-6.16, P = 0.000), Killip class ≥3 (OR 5.22, 95% CI 3.07-8.87, P = 0.000), extensive anterior myocardial infarction (OR 3.02, 95% CI 1.85-4.93, P = 0.000), use of furosemide (OR 1.02, 95% CI 1.02-1.03, P = 0.000), non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (OR 1.58, 95% CI 1.04-2.40, P = 0.032). These factors provided an accurate tool to identify patients at high risk of developing AKI.

Conclusions: Approximately 26.0% of patients undergoing AMI developed AKI, and the development of AKI was strongly correlated with in-hospital mortality. The risk factors for AKI in patients with AMI were determined to help identify high-risk patients and make appropriate clinical decisions.

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Figures

Figure 1
Figure 1
Acute kidney injury incidence and relative mortality among each group by stage. Overall, 26.0% patients developed AKI during the hospitalization, including 11.9% with stage 1, 9.1% with stage 2, and 5.0% with stage 3. Compared with non-AKI group, patients developed AKI have significantly higher in-hospital mortality that raises with stage of AKI (8.2%, 24.5%, and 42.9%, respectively, from stage 1 to 3). AKI: Acute kidney injury.
Figure 2
Figure 2
Discrimination of risk scores for developing AKI after AMI (n = 1124). Score considered age, hypertension, CKD, Killip classification, extensive anterior myocardial infarction, use of furosemide, and non-use of ACEI/ARB. The weight of each variable was calculated based on their respective multivariate analysis coefficient. ACEI/ARB: Angiotensin-converting enzyme inhibitors/angiotensin receptor blocker; AKI: Acute kidney injury; AMI: Acute myocardial infarction; CKD: Chronic kidney disease.
Figure 3
Figure 3
AKI score calibration. Our AKI risk score considers age (>60 years), hypertension, CKD, Killip class ≥3, extensive anterior myocardial infarction, use of furosemide and non-use of ACEI/ARB, one point for each risk factor. It is an accurate tool to identify patients at high risk of developing AKI. ACEI/ARB: Angiotensin-converting enzyme inhibitors/angiotensin receptor blocker; AKI: Acute kidney injury; CKD: Chronic kidney disease.
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