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. 2023 Sep 25;16(18):2294-2305.
doi: 10.1016/j.jcin.2023.07.041.

Contemporary Methods for Predicting Acute Kidney Injury After Coronary Intervention

Anezi Uzendu  1 , Kevin Kennedy  2 , Glenn Chertow  3 , Amit P Amin  4 , Jay S Giri  5 , Jennifer A Rymer  6 , Sripal Bangalore  7 , Kimberly Lavin  8 , Cornelia Anderson  8 , Tracy Y Wang  6 , Jeptha P Curtis  9 , John A Spertus  2
Affiliations

Contemporary Methods for Predicting Acute Kidney Injury After Coronary Intervention

Anezi Uzendu et al. JACC Cardiovasc Interv. .

Abstract

Background: Acute kidney injury (AKI) is the most common complication after percutaneous coronary intervention (PCI). Accurately estimating patients' risks not only creates a means of benchmarking performance but can also be used prospectively to inform practice.

Objectives: The authors sought to update the 2014 National Cardiovascular Data Registry (NCDR) AKI risk model to provide contemporary estimates of AKI risk after PCI to further improve care.

Methods: Using the NCDR CathPCI Registry, we identified all 2020 PCIs, excluding those on dialysis or lacking postprocedural creatinine. The cohort was randomly split into a 70% derivation cohort and a 30% validation cohort, and logistic regression models were built to predict AKI (an absolute increase of 0.3 mg/dL in creatinine or a 50% increase from preprocedure baseline) and AKI requiring dialysis. Bedside risk scores were created to facilitate prospective use in clinical care, along with threshold contrast doses to reduce AKI. We tested model calibration and discrimination in the validation cohort.

Results: Among 455,806 PCI procedures, the median age was 67 years (IQR: 58.0-75.0 years), 68.8% were men, and 86.8% were White. The incidence of AKI and new dialysis was 7.2% and 0.7%, respectively. Baseline renal function and variables associated with clinical instability were the strongest predictors of AKI. The final AKI model included 13 variables, with a C-statistic of 0.798 and excellent calibration (intercept = -0.03 and slope = 0.97) in the validation cohort.

Conclusions: The updated NCDR AKI risk model further refines AKI prediction after PCI, facilitating enhanced clinical care, benchmarking, and quality improvement.

Keywords: acute kidney injury; benchmarking; contrast-induced nephropathy; coronary angiography; percutaneous coronary intervention; risk model.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Anezi Uzendu is supported by the National Heart, Lung and Blood Institutes of Health under Award Number 5T32H110837. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Chertow serves on the Board of Directors of Satellite Healthcare, a nonprofit dialysis provider; has served as a steering committee member or chair for clinical trials sponsored by Akebia, AstraZeneca, CSL Behring, Gilead, Sanifit, and Vertex; has served as an advisor to Ardelyx, Durect, Eliaz Therapeutics, Miromatrix, Outset, Reata, Renibus, and Unicycive; and has served as a Data Safety and Monitoring Board member or chair for trials sponsored by Bayer, Gilead, Mineralys, Palladio, and ReCor. Dr Giri has received research funds to his institution; and has served on advisory boards for Boston Scientific, Abiomed, Abbott Vascular, Inari Medical, Biosense Webster, and Recor Medical. Dr Rymer has served on the advisory board for Chiesi; has received a research grant from Chiesi; and receives research funding from Idorsia, Pfizer, and Abbott. Dr Bangalore discloses has served on the advisory board for Abbott Vascular, Boston Scientific, Amgen, Pfizer, Merck, Inari, and Truvic. Dr Wang has received research grants to the Duke Clinical Research Institute from Abbott, AstraZeneca, Bristol Myers Squibb, Boston Scientific, Artivion (formerly Cryolife), Chiesi, Merck, Portola, and Regeneron; and has received consulting honoraria from AstraZeneca, Bristol Myers Squibb, Artivion (formerly Cryolife), CSL Behring, and Novartis. Dr Curtis has an institutional contract with the American College of Cardiology for his role as chief scientific adviser of the NCDR; and has equity in Medtronic. Dr Spertus has provided consultative services on patient-reported outcomes and evidence evaluation to Alnylam, AstraZeneca, Bayer, Merck, Janssen, Bristol Meyers Squibb, Edwards Lifesciences, Kineksia, 4DT Medical, Terumo, Cytokinetics, Imbria, and United Healthcare; holds research grants from Bristol Meyers Squibb, Abbott Vascular, and Janssen; owns the copyright to the Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire, and Peripheral Artery Questionnaire; and serves on the Board of Directors for Blue Cross Blue Shield of Kansas City. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

FIGURE 1
FIGURE 1. Study Population Consort Diagram
Cr = creatinine; PCI = percutaneous coronary intervention.
FIGURE 2
FIGURE 2. Calibration of the Full and Reduced Model AKI Models
Calibration curves for (A) the full acute kidney injury (AKI) model and (B) the reduced AKI model. These curves have observed rates on the x-axis and expected rates of AKI on the y-axis. For both the full and reduced models, the intercept is close to 0, and the slope is close to 1, indicating excellent calibration.
FIGURE 3
FIGURE 3. Bedside Risk Scores and Event Rates
Validation of the integer risk score for both (A) acute kidney injury (AKI) and (B) dialysis. This demonstrates that as the risk score increased, the observed event rates increased.
CENTRAL ILLUSTRATION:
CENTRAL ILLUSTRATION:. New Bedside Acute Kidney Injury Model
This demonstrates the new bedside acute kidney injury (AKI) model with its predictor variables and key performance metrics. Along the circle are individual predictors of AKI included in the model. The center of the figure displays performance demonstrating the C-statistic = 0.79 and AKI rates with increasing integer scores. ACS = acute coronary syndrome; NCDR = National Cardiovascular Data Registry.
See this image and copyright information in PMC

Comment in

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