A novel risk score for contrast-associated acute kidney injury: the heart of the matter

• Published in: The Lancet (British edition) Vol. 398; no. 10315; pp. 1941 - 1943
• Main Authors: Nijssen, Estelle C, Wildberger, Joachim E
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 27.11.2021; Elsevier Limited
• Subjects: Acute Kidney Injury - chemically induced; Angioplasty; Catheters; Congestive heart failure; Contrast agents; Coronary artery disease; Creatinine; End-stage renal disease; Health risks; Humans; Injury prevention; Intravenous administration; Kidney diseases; Kidneys; Medical instruments; Morbidity; Mortality; Mortality risk; Patients; Population characteristics; Prophylaxis; Renal insufficiency; Risk analysis; Risk Factors; Ventricle
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(21)02445-4

Interestingly, increases in serum creatinine akin to those in contrast-associated acute kidney injury definitions have been reported in patients who did not receive contrast at all.1–3 To further complicate matters, serum creatinine is directly affected by a large number of factors, many of which are encountered in the setting of contrast procedures, leading some to speculate that we are seeing signal where there is mostly noise.4 Despite these uncertainties, reports of associations between contrast-associated acute kidney injury and increased morbidity, longer hospital stays, and mortality risk are consistent, especially in patients with cardiac disease.5 Whether the relationship is causal or coincidental remains unclear, but the general assumption is that preventing contrast-associated acute kidney injury will prevent associated risks of adverse outcomes. To date, the only risk factor to be widely agreed upon is severe renal insufficiency, and even for this risk factor conflicting evidence exists.6–8 Nevertheless, current international guideline consensus is that patients at high risk are those with severe and end-stage chronic kidney disease, without other risk factor-based screening.9,10 In The Lancet, Roxana Mehran and colleagues11 propose a novel risk score based on only pre-procedural variables (Model 1) or both pre-procedural and procedural variables (Model 2) in a large database of patients undergoing percutaneous coronary intervention (derivation cohort n=14 616; validation cohort n=5606). [...]congestive heart failure and reduced left ventricular ejection fraction are themselves risk factors for complications of the only accepted prophylaxis to date, namely intravenous hydration.12 Kansas City Star/Getty Images It is difficult to distinguish between effects of population characteristics, comorbidities, and procedure characteristics (eg, catheter manipulation), and effects of the contrast itself.