Predicting Acute Kidney Injury in the Catheterization Laboratory ∗

There has been considerable advancement in catheters, wires, balloons, stents, and adjunctive strategies for procedures performed in the cardiac catheterization laboratory. Despite these improvements, angiographic procedures remain dependent on the use of water-soluble iodinated contrast that has inherent nephrotoxicity (1). In addition, coronary angiography with percutaneous coronary intervention (PCI) poses additional risks of renal atheroembolism, which may occur on a subclinical basis and contribute to acute kidney injury (AKI). In the settings of acute myocardial infarction and heart failure, there are hemodynamic, neurohormonal, and cytokine mechanisms of action, which are determinants for acute tubular injury in the absence of exposure to the catheterization procedure. With this backdrop, Inohara et al. (2) in this issue of the Journal analyzed 11,041 consecutive patients enrolled in a Japanese PCI registry with the goal of validating the U.S. National Cardiovascular Data Registry’s (NCDR) CathPCI registry prediction models for AKI and the need for renal replacement therapy (dialysis). The CathPCI registry prediction model included 11 variables for AKI and 6 for AKI requiring dialysis (AKI-D) (3). Both models were strongly influenced by 4 variables, in importance: 1) baseline renal function; 2) cardiogenic shock; 3) ST-segment elevation myocardial infarction (STEMI); and 4) heart failure. For patients without cardiogenic shock, STEMI, or heart failure, the most ...
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research