Impact of contrast-induced acute kidney injury definition on clinical outcomes

Carlo Budano, Mario Levis, Maurizio D'Amico, Tullio Usmiani, Antonella Fava, Pierluigi Sbarra, Manuel Burdese, Gian Paolo Segoloni, Antonio Colombo, Sebastiano Marra

Research output: Contribution to journalArticle

Abstract

Background: Contrast-induced acute kidney injury (CIAKI) is a frequent complication after infusion of contrast media in patients undergoing percutaneous coronary intervention. A wide range of CIAKI rates occurs after intervention between 3% and 30%, depending on the definition. The aim of this study was to identify which methodology was more effective at recognizing patients at high risk for in-hospital and out-of-hospital adverse events. Methods and Results: Serum creatinine increases, after contrast agent infusion, were evaluated in 755 consecutive and unselected patients. Incidences of CIAKI diagnosed by 2 common definitions varied from 6.9% (creatinine increase of ≥0.5 mg/dL, CIAKI-0.5) to 15.9% (creatinine increase of ≥25%, CIAKI-25%). Significant differences appeared between the 2 definitions of sensitivity to predict renal failure according to receiver operating characteristic curve analysis (98% for CIAKI-0.5 and 62% for CIAKI-25%), using a cutoff value of postprocedural glomerular filtration rate of 60 mL/min. Both definitions of CIAKI were related to composite adverse events, but CIAKI-0.5 showed a stronger predicting value (odds ratio 2.875 vs 1.802, P = .036). In multivariate linear regression, only CIAKI-0.5 was a predictive variable of death (odds ratio 3.174, 95% CI 1.368-7.361). Conclusions: An increase in serum creatinine of ≥0.5 mg/dL is more sensitive because it recognizes more selectively those patients with a higher risk of mortality and morbidity. Serum creatinine increases of ≥25% overestimate CIAKI by including many patients without postprocedural relevant deterioration of renal function and affected by a lower risk of adverse events at follow-up.

Original languageEnglish
Pages (from-to)963-971
Number of pages9
JournalAmerican Heart Journal
Volume161
Issue number5
DOIs
Publication statusPublished - May 2011

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Acute Kidney Injury
Creatinine
Contrast Media
Serum
Odds Ratio
Percutaneous Coronary Intervention
Glomerular Filtration Rate
ROC Curve
Renal Insufficiency
Linear Models
Morbidity
Kidney
Mortality
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Budano, C., Levis, M., D'Amico, M., Usmiani, T., Fava, A., Sbarra, P., ... Marra, S. (2011). Impact of contrast-induced acute kidney injury definition on clinical outcomes. American Heart Journal, 161(5), 963-971. https://doi.org/10.1016/j.ahj.2011.02.004

Impact of contrast-induced acute kidney injury definition on clinical outcomes. / Budano, Carlo; Levis, Mario; D'Amico, Maurizio; Usmiani, Tullio; Fava, Antonella; Sbarra, Pierluigi; Burdese, Manuel; Segoloni, Gian Paolo; Colombo, Antonio; Marra, Sebastiano.

In: American Heart Journal, Vol. 161, No. 5, 05.2011, p. 963-971.

Research output: Contribution to journalArticle

Budano, C, Levis, M, D'Amico, M, Usmiani, T, Fava, A, Sbarra, P, Burdese, M, Segoloni, GP, Colombo, A & Marra, S 2011, 'Impact of contrast-induced acute kidney injury definition on clinical outcomes', American Heart Journal, vol. 161, no. 5, pp. 963-971. https://doi.org/10.1016/j.ahj.2011.02.004
Budano C, Levis M, D'Amico M, Usmiani T, Fava A, Sbarra P et al. Impact of contrast-induced acute kidney injury definition on clinical outcomes. American Heart Journal. 2011 May;161(5):963-971. https://doi.org/10.1016/j.ahj.2011.02.004
Budano, Carlo ; Levis, Mario ; D'Amico, Maurizio ; Usmiani, Tullio ; Fava, Antonella ; Sbarra, Pierluigi ; Burdese, Manuel ; Segoloni, Gian Paolo ; Colombo, Antonio ; Marra, Sebastiano. / Impact of contrast-induced acute kidney injury definition on clinical outcomes. In: American Heart Journal. 2011 ; Vol. 161, No. 5. pp. 963-971.
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abstract = "Background: Contrast-induced acute kidney injury (CIAKI) is a frequent complication after infusion of contrast media in patients undergoing percutaneous coronary intervention. A wide range of CIAKI rates occurs after intervention between 3{\%} and 30{\%}, depending on the definition. The aim of this study was to identify which methodology was more effective at recognizing patients at high risk for in-hospital and out-of-hospital adverse events. Methods and Results: Serum creatinine increases, after contrast agent infusion, were evaluated in 755 consecutive and unselected patients. Incidences of CIAKI diagnosed by 2 common definitions varied from 6.9{\%} (creatinine increase of ≥0.5 mg/dL, CIAKI-0.5) to 15.9{\%} (creatinine increase of ≥25{\%}, CIAKI-25{\%}). Significant differences appeared between the 2 definitions of sensitivity to predict renal failure according to receiver operating characteristic curve analysis (98{\%} for CIAKI-0.5 and 62{\%} for CIAKI-25{\%}), using a cutoff value of postprocedural glomerular filtration rate of 60 mL/min. Both definitions of CIAKI were related to composite adverse events, but CIAKI-0.5 showed a stronger predicting value (odds ratio 2.875 vs 1.802, P = .036). In multivariate linear regression, only CIAKI-0.5 was a predictive variable of death (odds ratio 3.174, 95{\%} CI 1.368-7.361). Conclusions: An increase in serum creatinine of ≥0.5 mg/dL is more sensitive because it recognizes more selectively those patients with a higher risk of mortality and morbidity. Serum creatinine increases of ≥25{\%} overestimate CIAKI by including many patients without postprocedural relevant deterioration of renal function and affected by a lower risk of adverse events at follow-up.",
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AU - Budano, Carlo

AU - Levis, Mario

AU - D'Amico, Maurizio

AU - Usmiani, Tullio

AU - Fava, Antonella

AU - Sbarra, Pierluigi

AU - Burdese, Manuel

AU - Segoloni, Gian Paolo

AU - Colombo, Antonio

AU - Marra, Sebastiano

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N2 - Background: Contrast-induced acute kidney injury (CIAKI) is a frequent complication after infusion of contrast media in patients undergoing percutaneous coronary intervention. A wide range of CIAKI rates occurs after intervention between 3% and 30%, depending on the definition. The aim of this study was to identify which methodology was more effective at recognizing patients at high risk for in-hospital and out-of-hospital adverse events. Methods and Results: Serum creatinine increases, after contrast agent infusion, were evaluated in 755 consecutive and unselected patients. Incidences of CIAKI diagnosed by 2 common definitions varied from 6.9% (creatinine increase of ≥0.5 mg/dL, CIAKI-0.5) to 15.9% (creatinine increase of ≥25%, CIAKI-25%). Significant differences appeared between the 2 definitions of sensitivity to predict renal failure according to receiver operating characteristic curve analysis (98% for CIAKI-0.5 and 62% for CIAKI-25%), using a cutoff value of postprocedural glomerular filtration rate of 60 mL/min. Both definitions of CIAKI were related to composite adverse events, but CIAKI-0.5 showed a stronger predicting value (odds ratio 2.875 vs 1.802, P = .036). In multivariate linear regression, only CIAKI-0.5 was a predictive variable of death (odds ratio 3.174, 95% CI 1.368-7.361). Conclusions: An increase in serum creatinine of ≥0.5 mg/dL is more sensitive because it recognizes more selectively those patients with a higher risk of mortality and morbidity. Serum creatinine increases of ≥25% overestimate CIAKI by including many patients without postprocedural relevant deterioration of renal function and affected by a lower risk of adverse events at follow-up.

AB - Background: Contrast-induced acute kidney injury (CIAKI) is a frequent complication after infusion of contrast media in patients undergoing percutaneous coronary intervention. A wide range of CIAKI rates occurs after intervention between 3% and 30%, depending on the definition. The aim of this study was to identify which methodology was more effective at recognizing patients at high risk for in-hospital and out-of-hospital adverse events. Methods and Results: Serum creatinine increases, after contrast agent infusion, were evaluated in 755 consecutive and unselected patients. Incidences of CIAKI diagnosed by 2 common definitions varied from 6.9% (creatinine increase of ≥0.5 mg/dL, CIAKI-0.5) to 15.9% (creatinine increase of ≥25%, CIAKI-25%). Significant differences appeared between the 2 definitions of sensitivity to predict renal failure according to receiver operating characteristic curve analysis (98% for CIAKI-0.5 and 62% for CIAKI-25%), using a cutoff value of postprocedural glomerular filtration rate of 60 mL/min. Both definitions of CIAKI were related to composite adverse events, but CIAKI-0.5 showed a stronger predicting value (odds ratio 2.875 vs 1.802, P = .036). In multivariate linear regression, only CIAKI-0.5 was a predictive variable of death (odds ratio 3.174, 95% CI 1.368-7.361). Conclusions: An increase in serum creatinine of ≥0.5 mg/dL is more sensitive because it recognizes more selectively those patients with a higher risk of mortality and morbidity. Serum creatinine increases of ≥25% overestimate CIAKI by including many patients without postprocedural relevant deterioration of renal function and affected by a lower risk of adverse events at follow-up.

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