The Risk of Acute Kidney Injury in Patients Undergoing Coronary Angiography

Abstract

Objective: This study was conducted to estimate the risk of contrast-induced AKI (CI-AKI), among Saudi patients who underwent CA or PCI at a tertiary care hospital, to understand the incidence and the underlying contributory factors of CI-AKI. Methods: We conducted a retrospective review of patients who underwent CA or PCI from 1st January 2018 to 31st December 2020, at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia.   The exclusion criteria comprised age <18 years, preexisting chronic kidney disease (stage III–V), prior renal transplantation and records with missing key clinical information. Occurrence of AKI was defined using the “Kidney Disease: Improving Global Outcomes” (KDIGO) consensus definition. Statistical Package for the Social Sciences (SPSS) software, version 21 was used for statistical analysis. The prevalence is presented as a percentage with a 95% confidence level. P-value <0.05 was considered statistically significant. Results: We reviewed 825 patient files, of which 754 met the inclusion criteria. According to the KDIGO classification, the mean overall incidence of Stage I CI-AKI in our study cohort was 8.1%, while no patients developed stage II and III AKI. The incidence of CI-AKI was 6.4% in patients <55 years of age (n=264) and 7.8% in the age group of 55-70 years. A significantly higher incidence of 13.3% was seen in patients above the age of 70 years. The increase in the incidence of CI-AKI in patients above 70 years, versus their younger counterparts was statistically significant (P = 0.075). Conclusions: Based on the results of this study and past literature, the overall incidence of CI-AKI is around ≤10%, among patients undergoing CA or PCI; which seems lower than the high risk perception among cardiologists. While CI-AKI is a known post-procedural complication of CA or PCI, the apprehension of the potential risk of CI-AKI, should not defer or obstruct the decision to perform CA or PCI for deserving and needy candidates. Exercising caution among high-risk patients, individual risk-benefit assessment and employing well-established pre and peri-procedural prevention protocols can significantly mitigate the risk of CI-AKI; even among high-risk patients.