AGREEMENT BETWEEN LABORATORY AND POINT-OF-CARE CREATININE–BASED RISK ASSESSMENT FOR POST-CONTRAST ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING ANGIOGRAPHY

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https://storage.unitedwebnetwork.com/files/1099/6f11e81790ba22483f62d82c357d3ee3.pdf

Abstract Title *

AGREEMENT BETWEEN LABORATORY AND POINT-OF-CARE CREATININE–BASED RISK ASSESSMENT FOR POST-CONTRAST ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING ANGIOGRAPHY

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Co-author 1

Abduzhappar Gaipov abduzhappar.gaipov@nu.edu.kz Nazarbayev University School of Medicine Astana Kazakhstan *

Co-author 2

Alimzhan Muxunov alimzhan.muxunov@nu.edu.kz Nazarbayev University School of Medicine Astana Kazakhstan -

Co-author 3

Doskhan Kozhakhmet Doskhan.Kozhakhmet@nu.edu.kz Nazarbayev University School of Medicine Astana Kazakhstan -

Co-author 4

Symbat Bayakhmetova symbat.bayakhmetova@nu.edu.kz Nazarbayev University School of Medicine Astana Kazakhstan -

Co-author 5

Meruyert Madikenova m.madikenova@nu.edu.kz Nazarbayev University School of Medicine Astana Kazakhstan -

Co-author 6

Anara Abbay anara.abbay@nu.edu.kz Nazarbayev University School of Medicine Astana Kazakhstan -

Co-author 7

Zhanat Kuanshaliyeva kuanshalieva.zh@gmail.com University Medical Center Internal Medicine Astana Kazakhstan -

Co-author 8

Yerlan Zhumagulov yerlan.zhumagulov@gmail.com Multiprofile City Hospital 2 Angiography Laboratory Astana Kazakhstan -

Co-author 9

Marat Alikhanov m.alikhanov@gmail.com Multiprofile City Hospital 2 Angiography Laboratory Astana Kazakhstan -

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Rapid identification of patients at risk of contrast-induced acute kidney injury (AKI) is essential in acute settings such as myocardial infarction (MI) and stroke. Point-of-care (POC) creatinine testing offers immediate kidney function results, but its reliability compared with standard laboratory measurements remains uncertain. This study evaluated the agreement between laboratory and POC creatinine–based risk stratification and their association with subsequent AKI after contrast angiography.

Methods

In this prospective study, 295 adults undergoing contrast-enhanced angiography for acute stroke or MI were enrolled. Serum creatinine was measured both in the laboratory and by a POC device before contrast administration. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 equation, and risk categories for post-procedural AKI were derived using the Mehran scoring system. AKI was defined according to KDIGO criteria (≥1.5× baseline or ≥26.5 µmol/L increase within 7 days). Agreement between laboratory- and POC-based risk categories was assessed using weighted Cohen’s kappa.

Results

The mean age of participants was 63 years, and one-third were women. The distribution of Mehran categories based on laboratory measurements was: low 8.7%, moderate 26.8%, high 26.8%, and very high 37.8%. AKI occurred in 11.0% (14/127) of patients with available follow-up. Agreement between laboratory- and POC-based risk classifications was almost perfect (κ = 0.97, 95% CI 0.95–0.98). The correlation between laboratory and POC creatinine was moderate (r = 0.63, p < 0.001).

Table 1. Agreement between laboratory and point-of-care risk categories

Laboratory Risk Category	POC Low	POC Moderate	POC High	POC Very High	Total (n)
Low - 7,5% (<6 points)	25	1	0	0	26
Moderate - 14% (6–10)	2	106	2	0	110
High -26,1% (11–15)	0	5	69	1	75
Very High – 57,3% (≥16)	0	0	7	77	84
Total (n)	27	112	78	78	295

Percent agreement = 99.3%; Weighted κ = 0.97 (95% CI 0.95–0.98). Laboratory and POC creatinine showed moderate correlation (r = 0.63, p < 0.001).

Figure 1. Relationship between predicted contrast-induced nephropathy (CIN) risk categories and observed acute kidney injury (AKI) outcomes based on (a) point-of-care and (b) laboratory creatinine.

Conclusion

POC creatinine-based Mehran risk scoring shows excellent diagnostic agreement with the laboratory-based version for stratifying post-contrast AKI risk. POC testing may enable faster, reliable bedside identification of high-risk patients undergoing angiography for acute stroke or myocardial infarction.

Kewords