Trajectory of renal function change and kidney injury after percutaneous coronary intervention in patients with stable c
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ORIGINAL ARTICLE
Trajectory of renal function change and kidney injury after percutaneous coronary intervention in patients with stable coronary artery disease Yuki Deguchi1 · Yuichi Saito2,3 · Motohiro Nakao1 · Hirokazu Shiraishi1 · Naoya Sakamoto1 · Satoru Kobayashi1 · Yoshio Kobayashi3 Received: 28 July 2020 / Accepted: 4 September 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Acute kidney injury usually assessed within 48 h after percutaneous coronary intervention (PCI) is associated with poor clinical outcomes, and persistent kidney damage is also strongly related to long-term mortality. However, little is known about longitudinal renal function change from a very early period to long-term follow-up after PCI. A total of 327 patients with stable coronary artery disease underwent elective PCI. Renal function was assessed with serum creatinine levels and estimated glomerular filtration rate (eGFR) at baseline, 1 day after PCI, at 1 year and at the latest follow-up. Kidney injury was defined as an increase in creatinine levels ≥ 0.3 mg/dl or ≥ 50% from baseline at each timepoint. Major adverse cardiovascular events (MACE) was defined as a composite of death, myocardial infarction, and stroke. eGFR was significantly increased 1 day after PCI, while it was progressively decreased at 1-year and long-term follow-up (median 28 months). Overall, eGFR was declined by − 2.3 ml/min/1.73 m2 per year. Only one (0.3%) patient developed kidney injury 1 day after PCI, whereas kidney injury at 1-year and long-term follow-up was observed in 15 (4.6%) and 27 (8.3%). During the follow-up period, 23 (7.0%) patients had MACE. The incidence of subsequent MACE was significantly higher in patients with kidney injury at 1 year than those without. In conclusion, kidney injury within 24 h after elective PCI was rarely observed. eGFR was progressively decreased over time, and mid-term kidney injury at 1 year was associated with future MACE. Keywords Contrast-induced acute kidney injury · Percutaneous coronary intervention · Outcome
Introduction Contrast-induced nephropathy (CIN), recently termed “contrast-induced acute kidney injury”, is a potentially serious complication following coronary angiography and percutaneous coronary intervention (PCI) and is associated with poor prognosis even with the small decrements in kidney function [1, 2]. The incidence of CIN in patients undergoing PCI shows ample variations (3.3% to 14.5%) [3], depending * Yuichi Saito [email protected] 1
Division of Cardiology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
2
Yale University School of Medicine, New Haven, USA
3
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1‑8‑1 Inohana, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
on different definitions with some time windows for renal function assessment (e.g. 48 and 72 h) and thresholds of serum creatinine (SCr) increase (e.g. 0.3 and 0.5 mg/dl) [4]. Since early discharge after PCI is frequently employed in current real-world
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