Incidence, Risk Factors and Prognosis of Contrast-Induced Acute Kidney Injury in Acute Heart Failure Patients Undergoing Coronary Angiography

BACKGROUND AND OBJECTIVES: Heart failure (HF) is a well-known risk factor for contrast-induced acute kidney injury (CI-AKI). We sought to evaluate the risk factors and prognostic impact of CI-AKI in patients with AHF who undergo coronary angiography (CAG). METHODS: A total 594 patients with AHF underwent CAG from May 1, 2011 to December 31, 2013. CI-AKI was defined as an increase ≥25% or ≥0.5 mg/dL in serum creatinine at 48 hours after CAG or the initiation of dialysis after CAG. The deviation of body weight on CAG day from the dry weight (ΔBWT(CAG), %) was calculated for each patient. RESULTS: Overall, CI-AKI was observed in 24.7% of patients. Patients with CI-AKI had higher in-hospital death (16.3% vs. 5.1%, p<0.001; relative risk [RR], 2.50; 95% confidence interval [CI], 1.45–4.31) and 1-year post-discharge death (38.1% vs. 17.4%, p<0.001; hazard ratio, 2.16; 95% CI, 1.40–3.34) than those without CI-AKI. Patients with CI-AKI had greater ΔBWT(CAG) than those without CI-AKI (5.5±5.7% vs. 3.7±4.0%, p<0.001). A J-shaped association between the risk of CI-AKI and ΔBWT(CAG) was noted. In patients with weight excess (n=179), an increase of ΔBWT by 1% was associated with 9% (RR, 1.09; 95% CI, 1.03–1.16), while in patients with weight deficiency (n=86), a decrease of ΔBWT by 1% was associated with 11% increased risk for CI-AKI (RR, 1.11; 95% CI, 1.05–1.17). CONCLUSIONS: In AHF patients undergoing CAG CI-AKI is common and associated with worse clinical outcomes. Achieving optimum body weight before CAG may reduce the risk of CI-AKI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01389843