Persistent renal injury among patients undergoing primary coronary intervention -prevalence and predictors

Abstract Background One of the more common and serious complications of acute coronary syndrome is renal injury with numerous reports associating it to adverse outcomes. Common definitions for renal injury, AKI and chronic CKD are highly heterogenous leaving a wide gap between these two entities. Hence, in an effort to better understand and classify renal injuries, the term acute kidney disease (AKD) was implemented, describing prolonged renal injury, between 7 and 90 days following initial insult. We aimed to evaluate the prevalence and predictors of AKD among STEMI patients. Methods This retrospective observational study cohort included 2940 consecutive patients admitted with STEMI between the years 2008-2019. Renal function was assessed upon admission and routinely thereafter. Renal outcomes ware assessed according to KDIGO criteria while AKD was defined by an elevation of serum creatinine >35% for more than a week and less than 3 months. Results 252 subjects with STEMI that suffered AKI were included, of them 117 (46%) developed AKD, among CKD patients higher rated of AKD were observed (60%). Gender, KDIGO index ≥2, reduced ejection fraction and hemodynamic instability were associated with AKD, however only higher KDIGO severity index (≥2) remained significant (OR 2.62, 1.09-6.33, p=0.027) after multivariate regression analysis. In addition, AKD patients had higher 1-year mortality rates (HR 3.39, 95% CI 1.71-6.72, p<0.01,figure 1). This trend was mainly driven by the CKD sub-population where higher mortality rates for AKD on CKD were observed (HR 5.26, 95% CI 1.83-15.1, p<0.01,figure 2). Conclusion AKD is common among STEMI patients with AKI. The presence of CKD and higher KDIGO stage should prompt strict monitoring for early diagnosis, treatment and prevention of renal function deteriorationSurvival according to AKD occurenceWithout (A) vs. with (B) CKD