Anemia and periprocedural complications determine contrast‐associated acute kidney injury after recanalization of chronic coronary occlusions in chronic kidney disease

Abstract

AbstractBackgroundContrast‐associated acute kidney injury (CA‐AKI) is a potential risk associated with the percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO) particularly with pre‐existing chronic kidney disease (CKD). The determinants of CA‐AKI in patients with pre‐existing CKD in an era of advanced strategies of CTO recanalization techniques need to be considered for a risk evaluation of the procedure.MethodsA consecutive cohort of 2504 recanalization procedures for a CTO between 2013 and 2022 was analyzed. Of these, 514 (20.5%) were done in patients with CKD (estimated glomerular filtration rate < 60 ml/min based on the most recently used CKD Epidemiology Collaboration equation).ResultsThe rate of patients classified to have CKD would be lower with 14.2% using the Cockcroft‐Gault equation, and 18.1% using the modified Modification of Diet in Renal Disease equation. The technical success was high with 94.9% and 96.8% (p = 0.04) between patients with and without CKD. The incidence of CA‐AKI was 9.9% versus 4.3% (p < 0.001). The major determinants of CA‐AKI in patients with CKD were the presence of diabetes and a reduced ejection fraction, as well as periprocedural blood loss, whereas a higher baseline hemoglobin and the use of the radial approach prevented CA‐AKI.ConclusionsIn patients with CKD CTO PCI could be performed successfully at a higher cost of CA‐AKI. Correcting preprocedural anemia and avoiding intraprocedural blood loss may reduce the incidence of CA‐AKI.