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Randomized Controlled Trial
. 2020 Mar 24;75(11):1311-1320.
doi: 10.1016/j.jacc.2020.01.023.

Contrast-Associated Acute Kidney Injury and Serious Adverse Outcomes Following Angiography

Steven D Weisbord  1 , Paul M Palevsky  2 , James S Kaufman  3 , Hongsheng Wu  4 , Maria Androsenko  4 , Ryan E Ferguson  4 , Chirag R Parikh  5 , Deepak L Bhatt  6 , Martin Gallagher  7 ; PRESERVE Trial Investigators
Affiliations
Free article
Randomized Controlled Trial

Contrast-Associated Acute Kidney Injury and Serious Adverse Outcomes Following Angiography

Steven D Weisbord et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Contrast-associated acute kidney injury (CA-AKI) associates with an increased relative risk for serious adverse outcomes. However, the magnitude of this risk and the incidence of clinically significant CA-AKI derived from analyses of large cohorts with prospective assessment of CA-AKI and subsequent outcomes are unknown.

Objectives: This study sought to characterize the relative risk for and incidence of serious adverse outcomes following the development of CA-AKI and to explore whether CA-AKI mediates the association of pre-angiography estimated glomerular filtration rate with adverse outcomes.

Methods: Among 4,418 participants in the PRESERVE (Prevention of Serious Adverse Outcomes Following Angiography) trial with comprehensive baseline and outcome data, we assessed whether CA-AKI was associated with the 90-day outcome comprising death, need for dialysis, or persistent impairment in kidney function. We calculated the incidence of clinically significant CA-AKI (i.e., proportion of patients who developed CA-AKI and the 90-day outcome) and examined whether CA-AKI was a mediator of the association of baseline kidney function with the 90-day outcome.

Results: CA-AKI was associated with an increased relative risk for 90-day death, need for dialysis, or persistent kidney impairment (odds ratio: 3.93; 95% confidence interval: 2.82 to 5.49; p < 0.0001). The incidence of clinically significant CA-AKI was 1.2% (53 of 4,418 patients). CA-AKI was not a mediator of the association of pre-angiography estimated glomerular filtration rate with the primary outcome.

Conclusions: Whereas CA-AKI is associated with an increased relative risk of serious, adverse 90-day outcomes, the incidence of clinically significant CA-AKI is very low. CA-AKI does not mediate the association of the pre-angiography estimated glomerular filtration rate with these outcomes.

Keywords: angiography; contrast-associated acute kidney injury; mediation; outcomes.

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Comment in

  • Innocent, Guilty, and Acute Kidney Injury.
    Dauerman HL, Solomon RJ. Dauerman HL, et al. J Am Coll Cardiol. 2020 Mar 24;75(11):1321-1323. doi: 10.1016/j.jacc.2020.01.022. J Am Coll Cardiol. 2020. PMID: 32192659 No abstract available.

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