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Comparative Study
. 2021 Apr 15;21(1):183.
doi: 10.1186/s12872-021-01985-9.

Definition of acute kidney injury impacts prevalence and prognosis in ACS patients undergoing coronary angiography

Maren Weferling  1   2 , Christoph Liebetrau  1   2   3 , Daniel Kraus  4 , Philipp Zierentz  3 , Beatrice von Jeinsen  1   2 , Oliver Dörr  1   3 , Michael Weber  5 , Holger Nef  1   2   3 , Christian W Hamm  1   2   3 , Till Keller  6   7   8   9
Affiliations
Comparative Study

Definition of acute kidney injury impacts prevalence and prognosis in ACS patients undergoing coronary angiography

Maren Weferling et al. BMC Cardiovasc Disord. .

Abstract

Background: Development of acute kidney injury (AKI) in invasively managed patients with acute coronary syndrome (ACS) is associated with a markedly increased mortality risk. Different definitions of AKI are in use, leading to varying prevalence and outcome measurements. The aim of the present study is to analyze an ACS population undergoing coronary angiography for differences in AKI prevalence and outcome using four established AKI definitions.

Methods: 944 patients (30% female) were enrolled in a prospective registry between 2003 and 2005 with 6-month all-cause mortality as outcome measure. Four established AKI definitions were used: an increase in serum creatinine (sCR) ≥ 1.5 fold, ≥ 0.3 mg/dl, and ≥ 0.5 mg/dl and a decrease in eGFR > 25% from baseline (AKIN 1, AKIN 2, CIN, and RIFLE definition groups, respectively).

Results: AKI rates varied widely between the different groups. Using the CIN definition, AKI frequency was lowest (4.4%), whereas it was highest if the RIFLE definition was applied (13.2%). AKIN 2 displayed a twofold higher AKI prevalence compared with AKIN 1 (10.2% vs. 5.3% (p < 0.001)). AKI was a strong risk factor for mid-term mortality, with distinctive variability between the definitions. The lowest mortality risk was found in the RIFLE group (HR 6.0; 95% CI 3.7-10.0; p < 0.001), whereas CIN revealed the highest risk (HR 16.7; 95% CI 9.9-28.1; p < 0.001).

Conclusion: Prevalence and outcome in ACS patients varied considerably depending on the AKI definition applied. To define patients with highest renal function-associated mortality risk, use of the CIN definition seems to have the highest prognostic relevance.

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Conflict of interest statement

All authors state that they have no conflicts of interest regarding the manuscript’s contents.

Figures

Fig. 1
Fig. 1
Incidence of AKI according to the four different definitions stratified by the presence of CKD. AKI rates are presented as percentages for the overall cohort (black column), non-CKD (dark-grey column) and CKD patients (light grey column) according to the four different AKI definitions, respectively. P-values are given for comparison of AKI rates of the CKD and non-CKD groups
Fig. 2
Fig. 2
Development of AKI and mid-term mortaliy risk for the four different definitions. Association of AKI and 6-month mortality evaluated by hazard ratios with the corresponding 95% CI and level of significance (p-value) according to the four different AKI definitions after adjustment for CKD status, age and sex
See this image and copyright information in PMC

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