Acute Renal Failure After Coronary Intervention: Incidence, Risk Factors, and Relationship to Mortality

• Published in: The American journal of medicine Vol. 103; no. 5; pp. 368 - 375
• Main Authors: McCullough, Peter A, Wolyn, Robert, Rocher, Leslie L, Levin, Robert N, O’Neill, William W
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.1997; Elsevier; Elsevier Sequoia S.A
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - etiology; Acute Kidney Injury - mortality; Acute Kidney Injury - physiopathology; Aged; Aged, 80 and over; Biological and medical sciences; Blood Urea Nitrogen; Cardiovascular disease; Cardiovascular system; Contrast Media - adverse effects; Coronary Disease - blood; Coronary Disease - mortality; Coronary Disease - physiopathology; Coronary Disease - therapy; Creatinine - blood; Diabetes Complications; Female; Hospital Mortality; Humans; Incidence; Investigative techniques, diagnostic techniques (general aspects); Kidneys; Male; Medical disorders; Medical sciences; Middle Aged; Mortality; Odds Ratio; Predictive Value of Tests; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Risk Factors; Stroke Volume; Urology; Kidney disease; Human; Urinary system disease; Iatrogenic; Radiodiagnosis; Angiography; Acute; Mortality; Coronary artery; Incidence; Risk factor; Renal failure; Complication
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/S0002-9343(97)00150-2

PURPOSE: This study set out to define the incidence, predictors, and mortality related to acute renal failure (ARF) and acute renal failure requiring dialysis (ARFD) after coronary intervention. PATIENTS AND METHODS: Derivation-validation set methods were used in 1,826 consecutive patients undergoing coronary intervention with evaluation of baseline creatinine clearance (CrCl), diabetic status, contrast exposure, postprocedure creatinine, ARF, ARFD, in-hospital mortality, and long-term survival (derivation set). Multiple logistic regression was used to derive the prior probability of ARFD in a second set of 1,869 consecutive patients (validation set). RESULTS: The incidence of ARF and ARFD was 144.6/1,000 and 7.7/1,000 cases respectively. The cutoff dose of contrast below which there was no ARFD was 100 mL. No patient with a CrCl > 47 mL/min developed ARFD. These thresholds were confirmed in the validation set. Multivariate analysis found CrCl [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.77 to 0.89, P <0.00001], diabetes (OR = 5.47, 95% CI 1.40 to 21.32, P = 0.01), and contrast dose (OR = 1.008, 95% CI 1.002 to 1.013, P = 0.01) to be independent predictors of ARFD. Patients in the validation set who underwent dialysis had a predicted prior probability of ARFD of between 0.07 and 0.73. The in-hospital mortality for those who developed ARFD was 35.7% and the 2-year survival was 18.8%. CONCLUSION: The occurrence of ARFD after coronary intervention is rare (<1%) but is associated with high in-hospital mortality and poor long-term survival. Individual patient risk can be estimated from calculated CrCl, diabetic status, and expected contrast dose prior to a proposed coronary intervention.