Effect of kidney disease on all-cause and cardiovascular mortality in patients undergoing coronary angiography

Abstract

Acute kidney injury (AKI) occurred in 12.8% of patients undergoing surgery and is associated with increased mortality. Chronic kidney disease (CKD) is a well-known risk for death and cardiovascular disease (CVD). Effects of AKI and CKD on patients undergoing coronary angiography (CAG) remain incompletely defined. The aim of our study was to investigate the relationship between acute and CKD and mortality in patients undergoing CAG. The cohort study included 49,194 patients in the multicenter cohort from January 2007 to December 2018. Cox regression analyses and Fine-Gray proportional subdistribution risk regression analysis are used to examine the association between kidney disease and all-cause and cardiovascular mortality. In the present study, 13,989 (28.4%) patients had kidney disease. During follow-up, 6144 patients died, of which 4508 (73.4%) were due to CVD. AKI without CKD (HR: 1.54, 95% CI: 1.36–1.74), CKD without AKI (HR: 2.02, 95% CI: 1.88–2.17), AKI with CKD (HR: 3.26, 95% CI: 2.90–3.66), and end-stage kidney disease (ESKD; HR: 5.63, 95% CI: 4.40–7.20) were significantly associated with all-cause mortality. Adjusted HR (95% CIs) for cardiovascular mortality was significantly elevated among patients with AKI without CKD (1.78 [1.54–2.06]), CKD without AKI (2.28 [2.09–2.49]), AKI with CKD (3.99 [3.47–4.59]), and ESKD (6.46 [4.93–8.46]). In conclusion, this study shows that acute or CKD is present in up to one-third of patients undergoing CAG and is associated with a substantially increased mortality. These findings highlight the importance of perioperative management of kidney function, especially in patients with CKD.

Impact Statement

• What is already known on this subject? Acute kidney injury (AKI) occurred in 12.8% of patients undergoing surgery and is linked to a 22.2% increase in mortality. Chronic kidney disease (CKD) is a well-known risk for death and cardiovascular events. Effects of AKI and CKD on patients undergoing coronary angiography (CAG) remain incompletely defined.

• What do the results of this study add? This study shows that kidney disease is present in up to one-third of patients undergoing CAG and is associated with a substantially increased mortality. AKI and CKD are independent predicators for mortality in patients undergoing CAG.

• What are the implications of these findings for clinical practice and/or further research? These findings highlight the importance of perioperative management of kidney function, especially in patients with CKD.

Keywords:

• Kidney disease
• all-cause mortality
• cardiovascular mortality
• coronary angiograph

Acknowledgements

This article is further improved from the author’s conference abstract presented at the 33rd Great Wall International Congress of Cardiology Asian Heart Society Congress 2022: Li, Q., Shi, S., Huang, S., Deng, J., Chen, W., Liu, J., Liu, Y., (October 2022). Effect of kidney disease on all-cause and cardiovascular-specific mortality in patients undergoing coronary angiography. Link: https://www.scienceopen.com/hosted-document?doi=10.15212%2FCVIA.2022.0015

Ethical approval

The Ethics Committee of the Guangdong Provincial People’s Hospital approved the study (approval no. GDREC2019555H(R1)). All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Author contributions

Dr. Liu had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Y Liu and J Liu. Acquisition, analysis, or interpretation of data: Y Liu and J Liu. Drafting of the manuscript: Q Li, SS Shi, HZ Huang, JR Deng, WH Chen, XZ Lu, WG Lai, GX Liang, and YN Wang. Critical revision of the manuscript for important intellectual content: Y Liu, J Liu, Martin G, and Amanda W. Statistical analysis: Q Li and JR Deng. Obtained funding: Y Liu. Administrative, technical, or material support: Y Liu. Study supervision: JY Chen.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by grants from Beijing Lisheng Cardiovascular Health Foundation [LHJJ20141751], Guangdong Provincial People’s Hospital Foundation [DFJH201919], and National Science Foundation of China [81670339, 81970311]. The work was not funded by any industry sponsors.