Acute kidney injury in hospitalized AMI patients has declined
MedWire News: The incidence of acute kidney injury (AKI) in patients hospitalized with acute myocardial infarction (AMI) has decreased significantly in recent years, a study shows.
These findings come despite the aging population and rising prevalence of AKI risk factors, report Mikhail Kosiborod (University of Missouri, Kansas City, USA) and co-workers in the Archives of Internal Medicine.
They used data from 33,249 consecutive hospitalizations in 31,532 AMI patients across 56 US centers to examine the temporal trends in AKI incidence between 2000 and 2008.
AKI was defined as an absolute increase in creatinine level of at least 0.3 mg/dL or a relative increase of at least 50% during hospitalization.
The key risk factors for AKI increased significantly from 2000 to 2008, including mean age (66.5 to 68.6 years), chronic kidney disease (3.9 to 12.7%), and cardiogenic shock (4.3 to 5.7%). Diabetes mellitus (30.3 to 35.1%), heart failure (29.8 to 32.7%), use of coronary angiography (59.0 to 70.0%), and percutaneous coronary intervention (32.1 to 47.0%) also significantly increased during this period (p<0.001 for all comparisons).
Despite this, the incidence of AKI declined significantly over time, from 26.6% in 2000 to 19.7% in 2008 (p<0.001), which represented an absolute difference of 6.9%.
After adjusting for trends in potential confounders and practice pattern changes over time, the decline in AKI incidence per year was 4.4% (p<0.001).
In-hospital mortality also declined over time among AKI patients, from 19.9% in 2000 to 13.8% in 2008 (p=0.003). After adjusting for potential confounders, this association persisted, at an odds ratio for mortality of 0.96 per year (p=0.004) relative to the rate in 2000.
Multivariate analysis revealed that the magnitude of decline in AKI incidence was more substantial in patients who underwent cardiac catheterization, at a 5.6% decline per year (p=0.001) compared with a 3.3% decline per year in those treated conservatively (p=0.01).
This finding suggests that better AKI prevention efforts may be playing a role in the reduced AKI incidence among AMI patients, say the authors.
Editorialists Raymond Hsu and Chi-yuan Hsu (University of California, San Francisco, USA) comment: "In the future, we may be able to adopt AKI incidence among hospitalized patients as a quality and safety outcome measure… focusing attention on this may translate into considerable improvements in patient outcomes."
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By Piriya Mahendra