Author + information
- Received October 3, 2019
- Revision received December 17, 2019
- Accepted January 7, 2020
- Published online March 16, 2020.
- Steven D. Weisbord, MD, MSca,b,∗∗ (, )@stevenweisbord,
- Paul M. Palevsky, MDa,b,
- James S. Kaufman, MDc,d,
- Hongsheng Wu, PhDc,
- Maria Androsenko, MSc,
- Ryan E. Ferguson, ScDc,
- Chirag R. Parikh, MD, PhDe,
- Deepak L. Bhatt, MD, MPHf,
- Martin Gallagher, MD, PhDg,
- for the PRESERVE Trial Investigators
- aRenal Section, Medicine Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- bRenal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- cVeterans Affairs Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- dDivision of Nephrology, New York University School of Medicine, New York, New York
- eDivision of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland
- fBrigham and Women’s Hospital Heart and Vascular Center, Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
- gGeorge Institute for Global Health, Sydney, Australia
- ↵∗Address for correspondence:
Dr. Steven D. Weisbord, 7E Room 120, 111F-U, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240.
Background Contrast-associated acute kidney injury (CA-AKI) associates with an increased relative risk for serious adverse outcomes. However, the magnitude of this risk and the incidence of clinically significant CA-AKI derived from analyses of large cohorts with prospective assessment of CA-AKI and subsequent outcomes are unknown.
Objectives This study sought to characterize the relative risk for and incidence of serious adverse outcomes following the development of CA-AKI and to explore whether CA-AKI mediates the association of pre-angiography estimated glomerular filtration rate with adverse outcomes.
Methods Among 4,418 participants in the PRESERVE (Prevention of Serious Adverse Outcomes Following Angiography) trial with comprehensive baseline and outcome data, we assessed whether CA-AKI was associated with the 90-day outcome comprising death, need for dialysis, or persistent impairment in kidney function. We calculated the incidence of clinically significant CA-AKI (i.e., proportion of patients who developed CA-AKI and the 90-day outcome) and examined whether CA-AKI was a mediator of the association of baseline kidney function with the 90-day outcome.
Results CA-AKI was associated with an increased relative risk for 90-day death, need for dialysis, or persistent kidney impairment (odds ratio: 3.93; 95% confidence interval: 2.82 to 5.49; p < 0.0001). The incidence of clinically significant CA-AKI was 1.2% (53 of 4,418 patients). CA-AKI was not a mediator of the association of pre-angiography estimated glomerular filtration rate with the primary outcome.
Conclusions Whereas CA-AKI is associated with an increased relative risk of serious, adverse 90-day outcomes, the incidence of clinically significant CA-AKI is very low. CA-AKI does not mediate the association of the pre-angiography estimated glomerular filtration rate with these outcomes.
↵∗ The opinions and content expressed in this article are those of the authors and do not necessarily represent the views of the U.S.
Department of Veterans Affairs or the U.S. government. This work was funded by the Veterans Affairs Cooperative Studies Program and National Health and Medical Research Council of Australia. Dr. Weisbord has consulted for Saghmos Therapeutics and Cytokinetics. Dr. Palevsky has consulted for GE Healthcare. Dr. Bhatt has served on the Advisory Boards of Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, and Regado Biosciences; has served on the Boards of Directors of Boston Veterans Affairs Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; has chaired the American Heart Association Quality Oversight Committee; has served on the Data Monitoring Committees of Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO [Portico Resheathable Transcatheter Aortic Valve System] trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi-Sankyo), and Population Health Research Institute; has received honoraria from American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org; vice-chair, American College of Cardiology Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute); REDUAL-PCI (Evaluation of Dual Therapy With Dabigatran vs. Triple Therapy With Warfarin in Patients With Atrial Fibrillation That Undergo a Percutaneous Coronary Intervention With Stenting) Clinical Trial Steering Committee (funded by Boehringer Ingelheim); AEGIS-II (Study to Investigate CSL1122 in Subjects With Acute Coronary Syndrome) Executive Committee (funded by CSL Behring), Belvoir Publications (editor-in-chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (editor-in-chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor, associate editor), Medtelligence/ReachMD (continuing medical education steering committees), Population Health Research Institute (for the COMPASS [Cardiovascular Outcomes for People Using Anticoagulation Strategies] Operations Committee, Publications Committee, Steering Committee, and U.S. national coleader, funded by Bayer), Slack Publications (chief medical editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (secretary/treasurer), and WebMD (continuing medical education steering committees); has uncompensated relationships with Clinical Cardiology (deputy editor), NCDR-ACTION (National Cardiovascular Data Registry—Acute Coronary Treatment and Intervention Outcomes Network) Registry Steering Committee (chair), and Veterans Affairs CART (Clinical Assessment, Reporting, and Tracking) Research and Publications Committee (chair); has received research funding from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has served as site co-investigator for Biotronik, Boston Scientific, St. Jude Medical (now Abbott), and Svelte; has served as a trustee of American College of Cardiology; has performed unfunded research for FlowCo, Fractyl, Merck, Novo Nordisk, PLx Pharma, and Takeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 3, 2019.
- Revision received December 17, 2019.
- Accepted January 7, 2020.
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