Acute kidney injury following coronary revascularization procedures in patients with advanced CKD

Abduzhappar Gaipov, Miklos Z Molnar, Praveen K Potukuchi, Keiichi Sumida, Zoltan Szabo, Oguz Akbilgic, Elani Streja, Connie M Rhee, Santhosh K G Koshy, Robert B Canada, Kamyar Kalantar-Zadeh, Csaba P Kovesdy

Research output: Contribution to journalArticle

Abstract

Background: Previous studies reported that compared with percutaneous coronary interventions (PCIs), coronary artery bypass grafting (CABG) is associated with a reduced risk of mortality and repeat revascularization in patients with mild to moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). Information about outcomes associated with CABG versus PCI in patients with advanced stages of CKD is limited. We evaluated the incidence and relative risk of acute kidney injury (AKI) associated with CABG versus PCI in patients with advanced CKD.

Methods: We examined 730 US veterans with incident ESRD who underwent a first CABG or PCI up to 5 years prior to dialysis initiation. The association of CABG versus PCI with AKI was examined in multivariable adjusted logistic regression analyses.

Results: A total of 466 patients underwent CABG and 264 patients underwent PCI. The mean age was 64 ± 8 years, 99% were male, 20% were African American and 84% were diabetic. The incidence of AKI in the CABG versus PCI group was 67% versus 31%, respectively (P < 0.001). The incidence of all stages of AKI were higher after CABG compared with PCI. CABG was associated with a 4.5-fold higher crude risk of AKI {odds ratio [OR] 4.53 [95% confidence interval (CI) 3.28-6.27]; P < 0.001}, which remained significant after multivariable adjustments [OR 3.50 (95% CI 2.03-6.02); P < 0.001].

Conclusion: CABG was associated with a 4.5-fold higher risk of AKI compared with PCI in patients with advanced CKD. Despite other benefits of CABG over PCI, the extremely high risk of AKI associated with CABG should be considered in this vulnerable population when deciding on the optimal revascularization strategy.

Original languageEnglish
JournalNephrology Dialysis Transplantation
DOIs
Publication statusE-pub ahead of print - Jul 9 2018
Externally publishedYes

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Chronic Renal Insufficiency
Acute Kidney Injury
Coronary Artery Bypass
Percutaneous Coronary Intervention
Chronic Kidney Failure
Incidence
Odds Ratio
Confidence Intervals
Veterans
Vulnerable Populations
African Americans
Dialysis
Logistic Models
Regression Analysis

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Acute kidney injury following coronary revascularization procedures in patients with advanced CKD. / Gaipov, Abduzhappar; Molnar, Miklos Z; Potukuchi, Praveen K; Sumida, Keiichi; Szabo, Zoltan; Akbilgic, Oguz; Streja, Elani; Rhee, Connie M; Koshy, Santhosh K G; Canada, Robert B; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P.

In: Nephrology Dialysis Transplantation, 09.07.2018.

Research output: Contribution to journalArticle

Gaipov, A, Molnar, MZ, Potukuchi, PK, Sumida, K, Szabo, Z, Akbilgic, O, Streja, E, Rhee, CM, Koshy, SKG, Canada, RB, Kalantar-Zadeh, K & Kovesdy, CP 2018, 'Acute kidney injury following coronary revascularization procedures in patients with advanced CKD', Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfy178
Gaipov, Abduzhappar ; Molnar, Miklos Z ; Potukuchi, Praveen K ; Sumida, Keiichi ; Szabo, Zoltan ; Akbilgic, Oguz ; Streja, Elani ; Rhee, Connie M ; Koshy, Santhosh K G ; Canada, Robert B ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba P. / Acute kidney injury following coronary revascularization procedures in patients with advanced CKD. In: Nephrology Dialysis Transplantation. 2018.
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abstract = "Background: Previous studies reported that compared with percutaneous coronary interventions (PCIs), coronary artery bypass grafting (CABG) is associated with a reduced risk of mortality and repeat revascularization in patients with mild to moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). Information about outcomes associated with CABG versus PCI in patients with advanced stages of CKD is limited. We evaluated the incidence and relative risk of acute kidney injury (AKI) associated with CABG versus PCI in patients with advanced CKD.Methods: We examined 730 US veterans with incident ESRD who underwent a first CABG or PCI up to 5 years prior to dialysis initiation. The association of CABG versus PCI with AKI was examined in multivariable adjusted logistic regression analyses.Results: A total of 466 patients underwent CABG and 264 patients underwent PCI. The mean age was 64 ± 8 years, 99{\%} were male, 20{\%} were African American and 84{\%} were diabetic. The incidence of AKI in the CABG versus PCI group was 67{\%} versus 31{\%}, respectively (P < 0.001). The incidence of all stages of AKI were higher after CABG compared with PCI. CABG was associated with a 4.5-fold higher crude risk of AKI {odds ratio [OR] 4.53 [95{\%} confidence interval (CI) 3.28-6.27]; P < 0.001}, which remained significant after multivariable adjustments [OR 3.50 (95{\%} CI 2.03-6.02); P < 0.001].Conclusion: CABG was associated with a 4.5-fold higher risk of AKI compared with PCI in patients with advanced CKD. Despite other benefits of CABG over PCI, the extremely high risk of AKI associated with CABG should be considered in this vulnerable population when deciding on the optimal revascularization strategy.",
author = "Abduzhappar Gaipov and Molnar, {Miklos Z} and Potukuchi, {Praveen K} and Keiichi Sumida and Zoltan Szabo and Oguz Akbilgic and Elani Streja and Rhee, {Connie M} and Koshy, {Santhosh K G} and Canada, {Robert B} and Kamyar Kalantar-Zadeh and Kovesdy, {Csaba P}",
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T1 - Acute kidney injury following coronary revascularization procedures in patients with advanced CKD

AU - Gaipov, Abduzhappar

AU - Molnar, Miklos Z

AU - Potukuchi, Praveen K

AU - Sumida, Keiichi

AU - Szabo, Zoltan

AU - Akbilgic, Oguz

AU - Streja, Elani

AU - Rhee, Connie M

AU - Koshy, Santhosh K G

AU - Canada, Robert B

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba P

PY - 2018/7/9

Y1 - 2018/7/9

N2 - Background: Previous studies reported that compared with percutaneous coronary interventions (PCIs), coronary artery bypass grafting (CABG) is associated with a reduced risk of mortality and repeat revascularization in patients with mild to moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). Information about outcomes associated with CABG versus PCI in patients with advanced stages of CKD is limited. We evaluated the incidence and relative risk of acute kidney injury (AKI) associated with CABG versus PCI in patients with advanced CKD.Methods: We examined 730 US veterans with incident ESRD who underwent a first CABG or PCI up to 5 years prior to dialysis initiation. The association of CABG versus PCI with AKI was examined in multivariable adjusted logistic regression analyses.Results: A total of 466 patients underwent CABG and 264 patients underwent PCI. The mean age was 64 ± 8 years, 99% were male, 20% were African American and 84% were diabetic. The incidence of AKI in the CABG versus PCI group was 67% versus 31%, respectively (P < 0.001). The incidence of all stages of AKI were higher after CABG compared with PCI. CABG was associated with a 4.5-fold higher crude risk of AKI {odds ratio [OR] 4.53 [95% confidence interval (CI) 3.28-6.27]; P < 0.001}, which remained significant after multivariable adjustments [OR 3.50 (95% CI 2.03-6.02); P < 0.001].Conclusion: CABG was associated with a 4.5-fold higher risk of AKI compared with PCI in patients with advanced CKD. Despite other benefits of CABG over PCI, the extremely high risk of AKI associated with CABG should be considered in this vulnerable population when deciding on the optimal revascularization strategy.

AB - Background: Previous studies reported that compared with percutaneous coronary interventions (PCIs), coronary artery bypass grafting (CABG) is associated with a reduced risk of mortality and repeat revascularization in patients with mild to moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). Information about outcomes associated with CABG versus PCI in patients with advanced stages of CKD is limited. We evaluated the incidence and relative risk of acute kidney injury (AKI) associated with CABG versus PCI in patients with advanced CKD.Methods: We examined 730 US veterans with incident ESRD who underwent a first CABG or PCI up to 5 years prior to dialysis initiation. The association of CABG versus PCI with AKI was examined in multivariable adjusted logistic regression analyses.Results: A total of 466 patients underwent CABG and 264 patients underwent PCI. The mean age was 64 ± 8 years, 99% were male, 20% were African American and 84% were diabetic. The incidence of AKI in the CABG versus PCI group was 67% versus 31%, respectively (P < 0.001). The incidence of all stages of AKI were higher after CABG compared with PCI. CABG was associated with a 4.5-fold higher crude risk of AKI {odds ratio [OR] 4.53 [95% confidence interval (CI) 3.28-6.27]; P < 0.001}, which remained significant after multivariable adjustments [OR 3.50 (95% CI 2.03-6.02); P < 0.001].Conclusion: CABG was associated with a 4.5-fold higher risk of AKI compared with PCI in patients with advanced CKD. Despite other benefits of CABG over PCI, the extremely high risk of AKI associated with CABG should be considered in this vulnerable population when deciding on the optimal revascularization strategy.

U2 - 10.1093/ndt/gfy178

DO - 10.1093/ndt/gfy178

M3 - Article

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

ER -