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J Am Heart Assoc. 2016 Oct 14;5(10). pii: e003812.

Chronic Kidney Disease Progression and Cardiovascular Outcomes Following Cardiac Catheterization-A Population-Controlled Study.

Author information

  • 1The Dartmouth Institute for Health Policy and Clinical Practice and Section of Cardiology, Department of Medicine, Geisel School of Medicine, Lebanon, NH jbrown@dartmouth.edu.
  • 2Section of Nephrology, Fletcher Allen Health Center, University of Vermont, Burlington, VT.
  • 3Section of Nephrology and Research and Development Service, White River Junction Veterans Affairs Medical Center, Veterans Administration, White River Junction, VT.
  • 4VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO.
  • 5The Dartmouth Institute for Health Policy and Clinical Practice and Section of Cardiology, Department of Medicine, Geisel School of Medicine, Lebanon, NH.
  • 6Geriatrics Research, Education, and Clinical Care, Tennessee Valley Healthcare System, Veteran's Administration, Nashville, TN.
  • 7Department of Veterans Affairs, Veterans Rural Health Resource Center - Eastern Region, White River Junction, VT.
  • 8Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.

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.

KEYWORDS:

angioplasty; contrast media; kidney; morbidity; survival

PMID:
27742616
PMCID:
PMC5121483
DOI:
10.1161/JAHA.116.003812
[PubMed - in process]
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