LDL cholesterol as a novel risk factor for contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention

• Published in: Atherosclerosis Vol. 237; no. 2; pp. 453 - 459
• Main Authors: Liu, Yuan-hui, Liu, Yong, Chen, Ji-yan, Zhou, Ying-ling, Chen, Zhu-jun, Yu, Dan-qing, Luo, Jian-fang, Li, Hua-long, He, Yi-ting, Ye, Piao, Ran, Peng, Guo, Wei, Tan, Ning
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.12.2014
• Subjects: Acute Kidney Injury - pathology; Aged; Cardiovascular; Cholesterol, LDL - blood; Contrast Media - adverse effects; Contrast Media - chemistry; Contrast-induced acute kidney injury; Creatinine - blood; Female; Hospitalization; Humans; Incidence; Low density lipoprotein cholesterol; Male; Middle Aged; Myocardial Infarction - blood; Odds Ratio; Percutaneous Coronary Intervention; Prospective Studies; Regression Analysis; Risk Factors; Treatment Outcome; Contrast-induced acute kidney injury; Low density lipoprotein cholesterol; Percutaneous coronary intervention
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2014.10.022

Background: Low density lipoprotein cholesterol (LDL-C) is associated with endothelial dysfunction, inflammation and increased vasoconstriction, which are involved in the development of contrast-induced acute kidney injury (CI-AKI). However, whether LDL-C is an independent risk factor of CI-AKI in patients undergoing percutaneous coronary intervention (PCI) is unknown. Methods: We prospectively enrolled 3236 consecutive patients undergoing PCI between January 2010 and September 2012. Multivariate logistic regression analysis was used to determine whether LDL-C is an independent risk factor of CI-AKI. CI-AKI was defined as an absolute increase in serum creatinine of ≥0.5 mg/dL or ≥25% over the baseline value within 48–72 h after contrast exposure. Results: CI-AKI was observed in 338 patients (10.4%). Patients with CI-AKI had a significantly higher rate of in hospital mortality (4.4% vs. 0.5%, p < 0.001), and significantly higher rates of other in hospital complications compared with those without CI-AKI. The LDL-C quartiles were as follows: Q1 (<2.04 mmol/L), Q2 (2.04–2.61 mmol/L), Q3 (2.61–3.21 mmol/L) and Q4 (>3.21 mmol/L). Patients with high baseline LDL-C levels were more likely to develop CI-AKI and composite end points including all-cause mortality, renal replacement therapy, non-fatal myocardial infarction, acute heart failure, target vessel revascularization or cerebrovascular accident during the observation period of hospitalization (8.9%, 9.9%, 10.5%, 12.6%, p = 0.001, and 5.0%, 5.2%, 6.1%, 8.1%, respectively; p = 0.007). Univariate logistic analysis showed that LDL-C levels (increment 1 mmol/L) were significantly associated with CI-AKI (odds ratio = 1.25, 95% confidence interval (CI), 1.11–1.39, p < 0.001). Furthermore, LDL-C remained a significant risk factor of CI-AKI (odds ratio = 1.23, 95% CI, 1.04–1.45, p = 0.014), even after adjusting for potential confounding risk factors. Conclusions: Measurement of plasma LDL-C concentrations in patients undergoing PCI may be helpful to identify those who are at risk of CI-AKI and poor in hospital outcomes. •LDL-C is significantly and independently associated with CI-AKI in patients undergoing PCI.•A high level of LDL-C is associated with poor in hospital outcomes.•LDL-C as an adjunct to established risk factors is useful for evaluating the risk of CI-AKI.