THE ASSOCIATION BETWEEN MILD ACUTE KIDNEY INJURY POST-PRIMARY PERCUTANEOUS CORONARY INTERVENTION AND THE LONG-TERM RENAL DECLINE

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THE ASSOCIATION BETWEEN MILD ACUTE KIDNEY INJURY POST-PRIMARY PERCUTANEOUS CORONARY INTERVENTION AND THE LONG-TERM RENAL DECLINE

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Co-author 1

Jieru Cai cai.jieru@zs-hospital.sh.cn Zhongshan Hospital, Fudan University Nephrology Shanghai China -

Co-author 2

Yang Zhang zhang.yang@zs-hospital.sh.cn Zhongshan Hospital, Fudan University Nephrology Shanghai China -

Co-author 3

Ying Huang huang.ying@zsxm-hospital.sh.cn Zhongshan Hospital, Fudan University Nephrology Shanghai China -

Co-author 4

Xiaoqiang Ding ding.xiaoqiang@zs-hospital.sh.cn Zhongshan Hospital, Fudan University Nephrology Shanghai China -

Co-author 5

Chenguang Li li.chenguang@zs-hospital.sh.cn Zhongshan Hospital, Fudan University Cardiology Shanghai China -

Co-author 6

Shengzhuo Yao youshengzhuo2001@163.com Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China *

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

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Introduction

The aim was to determine the long-term renal implications of mild acute kidney injury (AKI) after primary percutaneous coronary intervention (pPCI) and to develop a simple risk-prediction model for renal function decline.

Methods

This single-center retrospective cohort study enrolled 1399 patients who underwent pPCI at Zhongshan Hospital, Fudan University, between Jan 2013 and Mar 2021. These patients had preoperative, postoperative, and long-term (follow-up>90 days after procedure) serum creatinine measurements. The exposure (mild AKI post pPCI) and outcome (long-term renal decline) were defined according to the KDIGO guideline. The primary outcome was the association between mild AKI post-pPCI and long-term renal decline.

Results

The incidence of stage 1 AKI was 21% (293/1399). During a median follow-up of 40 months, Kaplan-Meier analysis revealed a significantly higher rate of renal decline in the mild AKI group compared to the non-AKI group. Multivariable Cox regression confirmed that mild AKI was independently associated with an increased risk of long-term renal decline (adjusted HR 3.3, 95% CI 2.65-4.1). A nomogram incorporating eight clinical variables was constructed to predict 1-, 5-, and 10-year probability of renal decline. The model demonstrated good predictive accuracy, with area under the curve (AUC) values of 0.785 in the training set and 0.741 in the test set.

Conclusion

Mild AKI following pPCI is significantly associated with a heightened risk of long-term renal decline. The proposed nomogram offers a practical tool for risk stratification, enabling targeted renal follow-up in high-risk patients.

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