Association of acute kidney injury and chronic kidney disease with processes of care and long-term outcomes in patients with acute myocardial infarction

Purav Mody, Tracy Wang, Robert McNamara, Sandeep R Das, Shuang Li, Karen Chiswell, Thomas Tsai, Dharam J Kumbhani, Stephen Wiviott, Abhinav Goyal, Matthew Roe, James A de Lemos

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Aims To examine the association of acute kidney injury (AKI) with long-term outcomes after myocardial infarction (MI), and evaluate whether effect modification is present according to baseline chronic kidney disease (CKD) status. Methods and results ACTION Registry records from 2008 to 2012 were linked to Medicare claims data, creating a cohort of 76 500 acute MI patients aged ≥ 65 years who survived to hospital discharge. Mild, moderate, and severe AKI were defined as changes in creatinine from baseline to peak of 0.3 to < 0.5, 0.5 to < 1.0, and ≥ 1.0 mg/dL, respectively. Stage 3, Stage 4, and Stage 5 CKD were defined as estimated glomerular filtration rates of 30-59, 15-29, and <15 mL/min/m 2, respectively. Cox proportional hazards modelling was used to examine associations of AKI with long-term outcomes. The prevalence of baseline CKD was: Stage 3 (41.2%), Stage 4 (6.7%), and Stage 5 (1.0%). The incidence of AKI was: Mild (7.5%), moderate (6.0%), and severe (3.0%). A significant interaction of AKI with baseline CKD was observed for 1-year mortality (P interaction <0.001). Acute kidney injury was associated with worse multivariable-adjusted 1-year mortality among individuals without CKD: Mild AKI [hazard ratio (HR): 1.33, 95% confidence interval (CI): 1.22-1.49], moderate AKI (HR:1.66, 95% CI: 1.46-1.89), and severe AKI (HR: 2.87, 95% CI: 2.41-3.43). An attenuation of this effect was noted with advancing stages of baseline CKD such that among patients with Stage 5 CKD, AKI was not associated with 1-year mortality. Conclusion Acute kidney injury is associated with worse long-term outcomes after MI. This effect is modified by baseline CKD status.

Original languageEnglish (US)
Pages (from-to)43-50
Number of pages8
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2018

Keywords

  • Discharge medications
  • Kidney injury
  • Myocardial infarction
  • Outcomes

ASJC Scopus subject areas

  • Health Policy
  • Cardiology and Cardiovascular Medicine

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