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Chronic Kidney Disease Progression and Cardiovascular Outcomes Following Cardiac Catheterization — A Population ‐ Controlled Study

View Article: PubMed Central - PubMed

ABSTRACT

Background: Studies of kidney disease associated with cardiac catheterization typically rely on billing records rather than laboratory data. We examined the associations between percutaneous coronary interventions, acute kidney injury, and chronic kidney disease progression using comprehensive Veterans Affairs clinical and laboratory databases.

Methods and results: Patients undergoing percutaneous coronary interventions between 2005 and 2010 (N=24 405) were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking registry and examined for associated acute kidney injury and chronic kidney disease development or progression relative to 24 405 matched population controls. Secondary outcomes analyzed included dialysis, acute myocardial infarction, and mortality. The incidence of chronic kidney disease progression following percutaneous coronary interventions complicated by acute kidney injury, following uncomplicated coronary interventions, and in matched controls were 28.66, 11.15, and 6.81 per 100 person‐years, respectively. Percutaneous coronary intervention also increased the likelihood of chronic kidney disease progression in both the presence and absence of acute injury relative to controls in adjusted analyses (hazard ratio [HR], 5.02 [95% CI, 4.68–5.39]; and HR, 1.76 [95% CI, 1.70–1.86]). Among patients with estimated glomerular filtration rate <60 mL/min per 1.73 m2, acute kidney injury increased the likelihood of disease progression by 8‐fold. Similar results were observed for all secondary outcomes.

Conclusions: Acute kidney injury following percutaneous coronary intervention was associated with increased chronic kidney disease development and progression and mortality.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier time to event plots for incident chronic kidney disease (CKD) (laboratory values only). Kaplan–Meier curves are plotted from the time of percutaneous coronary intervention (or the beginning of the study period for controls) to incident CKD events defined by laboratory values only and stratified by 3 groups: percutaneous coronary intervention complicated by cardiac catheterization–associated acute kidney injury (red), uncomplicated percutaneous coronary intervention (ie, without cardiac catheterization–associated acute kidney injury; blue), and matched controls (green).
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jah31826-fig-0004: Kaplan–Meier time to event plots for incident chronic kidney disease (CKD) (laboratory values only). Kaplan–Meier curves are plotted from the time of percutaneous coronary intervention (or the beginning of the study period for controls) to incident CKD events defined by laboratory values only and stratified by 3 groups: percutaneous coronary intervention complicated by cardiac catheterization–associated acute kidney injury (red), uncomplicated percutaneous coronary intervention (ie, without cardiac catheterization–associated acute kidney injury; blue), and matched controls (green).

Mentions: Overall incidence rates of CKD development or progression for CCA‐AKI, uncomplicated PCI (ie, without CCA‐AKI development), and matched controls were 28.66 (per 100 person‐years), 11.15, and 6.81, respectively (Figure 2, Table 3). PCI patients—both with and without CCA‐AKI—exhibited a 3‐ to 8‐fold higher likelihood of CKD progression over 5 years in adjusted analyses (HRCCA‐AKI, 5.02; 95% CI, 4.68–5.39 [P<0.001]; HRPCI, 1.76; 95% CI, 1.70–1.86 [P<0.001]; Table 3). CCA‐AKI increased CKD progression risk by ≈2‐ to 3‐fold in PCI patients over 5 years in adjusted analyses (HRCCA‐AKI, 2.51; 95% CI, 2.34–2.69 [P<0.001]). CCA‐AKI similarly increased the risk of CKD development in PCI patients with prior normal kidney function (Table 3, Figures 3 and 4).


Chronic Kidney Disease Progression and Cardiovascular Outcomes Following Cardiac Catheterization — A Population ‐ Controlled Study
Kaplan–Meier time to event plots for incident chronic kidney disease (CKD) (laboratory values only). Kaplan–Meier curves are plotted from the time of percutaneous coronary intervention (or the beginning of the study period for controls) to incident CKD events defined by laboratory values only and stratified by 3 groups: percutaneous coronary intervention complicated by cardiac catheterization–associated acute kidney injury (red), uncomplicated percutaneous coronary intervention (ie, without cardiac catheterization–associated acute kidney injury; blue), and matched controls (green).
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5121483&req=5

jah31826-fig-0004: Kaplan–Meier time to event plots for incident chronic kidney disease (CKD) (laboratory values only). Kaplan–Meier curves are plotted from the time of percutaneous coronary intervention (or the beginning of the study period for controls) to incident CKD events defined by laboratory values only and stratified by 3 groups: percutaneous coronary intervention complicated by cardiac catheterization–associated acute kidney injury (red), uncomplicated percutaneous coronary intervention (ie, without cardiac catheterization–associated acute kidney injury; blue), and matched controls (green).
Mentions: Overall incidence rates of CKD development or progression for CCA‐AKI, uncomplicated PCI (ie, without CCA‐AKI development), and matched controls were 28.66 (per 100 person‐years), 11.15, and 6.81, respectively (Figure 2, Table 3). PCI patients—both with and without CCA‐AKI—exhibited a 3‐ to 8‐fold higher likelihood of CKD progression over 5 years in adjusted analyses (HRCCA‐AKI, 5.02; 95% CI, 4.68–5.39 [P<0.001]; HRPCI, 1.76; 95% CI, 1.70–1.86 [P<0.001]; Table 3). CCA‐AKI increased CKD progression risk by ≈2‐ to 3‐fold in PCI patients over 5 years in adjusted analyses (HRCCA‐AKI, 2.51; 95% CI, 2.34–2.69 [P<0.001]). CCA‐AKI similarly increased the risk of CKD development in PCI patients with prior normal kidney function (Table 3, Figures 3 and 4).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Studies of kidney disease associated with cardiac catheterization typically rely on billing records rather than laboratory data. We examined the associations between percutaneous coronary interventions, acute kidney injury, and chronic kidney disease progression using comprehensive Veterans Affairs clinical and laboratory databases.

Methods and results: Patients undergoing percutaneous coronary interventions between 2005 and 2010 (N=24&nbsp;405) were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking registry and examined for associated acute kidney injury and chronic kidney disease development or progression relative to 24&nbsp;405 matched population controls. Secondary outcomes analyzed included dialysis, acute myocardial infarction, and mortality. The incidence of chronic kidney disease progression following percutaneous coronary interventions complicated by acute kidney injury, following uncomplicated coronary interventions, and in matched controls were 28.66, 11.15, and 6.81 per 100&nbsp;person&#8208;years, respectively. Percutaneous coronary intervention also increased the likelihood of chronic kidney disease progression in both the presence and absence of acute injury relative to controls in adjusted analyses (hazard ratio [HR], 5.02 [95% CI, 4.68&ndash;5.39]; and HR, 1.76 [95% CI, 1.70&ndash;1.86]). Among patients with estimated glomerular filtration rate &lt;60&nbsp;mL/min per 1.73&nbsp;m2, acute kidney injury increased the likelihood of disease progression by 8&#8208;fold. Similar results were observed for all secondary outcomes.

Conclusions: Acute kidney injury following percutaneous coronary intervention was associated with increased chronic kidney disease development and progression and mortality.

No MeSH data available.


Related in: MedlinePlus