Table 1.
Patient and Procedural Characteristics
| No AKI | AKI | OR (95% CI) | P Value | |
|---|---|---|---|---|
| Procedures (n=115 633) | 99 596 | 16 037 | ||
| Comorbidities | ||||
| Age | 65.2±9.5 | 67.2±10.0 | 1.02 (1.02–1.02) | <0.001 |
| Female | 2.2 | 2.1 | 0.93 (0.83–1.05) | 0.233 |
| Nonwhite race | 22.8 | 26.7 | 1.23 (1.19–1.28) | <0.001 |
| Tobacco use (any) | 38.7 | 34.1 | 0.82 (0.79–0.85) | <0.001 |
| Prior tobacco use | 52.7 | 47.5 | 0.81 (0.79–0.84) | <0.001 |
| Prior comorbidities | ||||
| Prior catheterization | 43.9 | 24.3 | 0.41 (0.40–0.43) | <0.001 |
| 0 to 1 days from catheterization | 33.4 | 19.1 | 0.47 (0.45–0.49) | <0.001 |
| 0 to 2 days from catheterization | 34.2 | 19.9 | 0.48 (0.46–0.50) | <0.001 |
| Days from catheterization | 15.5±87.5 | 12.8±77.4 | 1.00 (1.00–1.00) | 0.064 |
| Prior PCI | 33.5 | 25.5 | 0.68 (0.66–0.71) | <0.001 |
| Prior CABG | 12.9 | 11.1 | 0.85 (0.80–0.89) | <0.001 |
| Prior MI | 28.1 | 30.2 | 1.11 (1.07–1.15) | <0.001 |
| Prior stroke | 7.9 | 8.5 | 1.08 (1.02–1.14) | 0.014 |
| Diabetes | 48.5 | 51.8 | 1.14 (1.10–1.18) | <0.001 |
| Dyslipidemia | 74.4 | 65.9 | 0.66 (0.64–0.69) | <0.001 |
| Hypertension | 78.6 | 76.2 | 0.87 (0.84–0.91) | <0.001 |
| Hypotension | 8.8 | 11.3 | 1.33 (1.26–1.40) | <0.001 |
| Mitral regurgitation | 0.5 | 0.5 | 0.99 (0.77–1.26) | 0.911 |
| Peripheral vascular disease | 19.2 | 22.8 | 1.24 (1.19–1.29) | <0.001 |
| Number of prior comorbid events | ||||
| Number of prior admissions | 0.7±1.2 | 0.9±1.6 | 1.12 (1.11–1.14) | <0.001 |
| CHF | 0.02±0.14 | 0.02±0.14 | 1.06 (0.95–1.20) | 0.286 |
| CHF 7 to 365 days | 24.1 | 35.8 | 1.76 (1.70–1.82) | <0.001 |
| CKD | 0.4±1.9 | 1.1±3.3 | 1.11 (1.10–1.11) | <0.001 |
| Diabetes | 4.1±7.7 | 5.1±9.1 | 1.01 (1.01–1.02) | <0.001 |
| Dyslipidemia | 2.6±3.0 | 2.4±3.1 | 0.97 (0.97–0.98) | <0.001 |
| Hypertension | 4.1±5.6 | 4.5±6.4 | 1.01 (1.01–1.02) | <0.001 |
| Hypoalbuminemia 7 to 30 days | 5.5 | 13.9 | 2.77 (2.62–2.91) | <0.001 |
| Hypoalbuminemia 7 to 90 days | 9.6 | 19.91 | 2.34 (2.24–2.45) | <0.001 |
| Hypotension | 0.1±0.8 | 0.2±0.9 | 1.07 (1.05–1.09) | <0.001 |
| Peripheral vascular disease | 0.8±2.9 | 1.0±3.4 | 1.02 (1.02–1.03) | <0.001 |
| Anemia 3‐days | 32.6 | 52.6 | 2.29 (2.22–2.37) | <0.001 |
| Anemia 3 to 90 days | 33.1 | 46.5 | 1.76 (1.71–1.82) | <0.001 |
| Anemia 3 to 365 days | 46.4 | 58.6 | 1.64 (1.58–1.69) | <0.001 |
| Shock events | 0.0007±0.0454 | 0.0043±0.0943 | 2.22 (1.70–2.90) | <0.001 |
| CHF events | 0.3±1.0 | 0.6±1.5 | 1.23 (1.21–1.24) | <0.001 |
| CKD events | 0.05±0.37 | 0.13±0.63 | 1.37 (1.33–1.41) | <0.001 |
| Dyslipidemia events | 0.25±0.66 | 0.21±0.64 | 0.90 (0.87–0.92) | <0.001 |
| Prior renal complications and function | ||||
| Prior CKD | 13.1 | 24.4 | 2.14 (2.05–2.23) | <0.001 |
| Prior AKI (KDIGO) | 11.0 | 29.8 | 3.45 (3.32–3.59) | <0.001 |
| Prior highest AKIN Stage | 1.83 (1.78–1.87) | <0.001 | ||
| AKIN Stage 1 | 17.9 | 27.4 | ||
| AKIN Stage 2 | 2.5 | 7.7 | ||
| AKIN Stage 3 | 0.6 | 1.7 | ||
| Prior CIN (>0.5) | 15.2 | 30.1 | 2.41 (2.32–2.50) | <0.001 |
| Prior ARF (ICD9) | 6.5 | 15.5 | 2.64 (2.52–2.78) | <0.001 |
| Number of prior AKI admissions | 0.0003±0.0164 | 0.0006±0.0249 | 2.35 (1.15–4.79) | 0.019 |
| Number of prior CKD admissions | 0.0025±0.0547 | 0.0082±0.1097 | 2.48 (2.05–3.02) | <0.001 |
| Change in eGFR prior year | 0.9±13.7 | 1.3±17.4 | 1.00 (1.00–1.00) | 0.001 |
| Decline in eGFR prior year | 3.5±8.2 | 3.8±11.5 | 0.99 (0.99–0.99) | <0.001 |
| CKD | 6.9 | 13.4 | 2.07 (1.96–2.18) | <0.001 |
| eGFR <60, mL/min per m2 | 14.8 | 33.5 | 2.90 (2.79–3.01) | <0.001 |
| eGFR <45, mL/min per m2 | 5.0 | 18.1 | 4.17 (3.96–4.38) | <0.001 |
| eGFR <30, mL/min per m2 | 0.9 | 6.7 | 8.14 (7.43–8.92) | <0.001 |
| Medications | ||||
| ARB | 9.56 | 9.6 | 1 (0.95–1.06) | 0.893 |
| ACE | 41.78 | 38.9 | 0.888 (0.86–0.92) | <0.001 |
| Loop diuretic | 18.99 | 28.4 | 1.69 (1.63–1.76) | <0.001 |
| K‐sparing diuretic | 5.77 | 7.7 | 1.37 (1.29–1.46) | <0.001 |
| Statins | 62.03 | 54.2 | 0.72 (0.70–0.75) | <0.001 |
| Aminoglycosides | 0.1 | 0.1 | 0.79 (0.47–1.34) | 0.387 |
| Cimetidine | 0.1 | 0.1 | 0.47 (0.24–0.93) | 0.031 |
| Cyclosporine | 0.3 | 0.4 | 1.46 (1.11–1.90) | 0.006 |
| N‐acetylcysteine | 2.6 | 1.7 | 0.67 (0.59–0.75) | <0.001 |
| NSAIDS | 11.2 | 7.8 | 0.67 (0.63–0.71) | <0.001 |
| Trimethoprim | 0.9 | 1.1 | 1.21 (1.03–1.42) | 0.024 |
| Thrombolytic use | 0.03 | 0.02 | 0.89 (0.31–2.53) | 0.823 |
| At presentation | ||||
| Hypertension | 43.6 | 45.7 | 1.09 (1.05–1.12) | <0.001 |
| Hypotension | 22.2 | 32.4 | 1.68 (1.62–1.75) | <0.001 |
| Prepresent MI | 15.1 | 17.9 | 1.23 (1.18–1.28) | <0.001 |
| Acute coronary syndrome | 23.9 | 32.1 | 1.51 (1.46–1.56) | <0.001 |
| Anemia | 32.6 | 52.6 | 2.29 (2.22–2.37) | <0.001 |
| Shock | 0.4 | 4.3 | 10.22 (9.06–11.55) | <0.001 |
| CHF | 0.4 | 4.3 | 10.23 (9.06–11.55) | <0.001 |
| Dyslipidemia | 34.2 | 29.6 | 0.81 (0.78–0.84) | <0.001 |
| Unstable angina | 9.2 | 4.1 | 0.42 (0.39–0.46) | <0.001 |
| Ejection fraction ≤40% | 4.05 | 5.58 | 1.40 (1.30–1.51) | <0.001 |
| Pre creatine‐kinase ≥100 | 6.9 | 7.7 | 1.11 (1.05–1.19) | 0.001 |
| Pre CKMB ≥2.66 | 4.2 | 6.1 | 1.49 (1.38–1.60) | <0.001 |
| Preprocedural volume supplementation | ||||
| Pre IV normal saline, mL | 95.3±373.9 | 100.2±386.1 | 1.00 (1.00–1.00) | 0.177 |
| Pre IV total fluids, mL | 176.0±593.2 | 176.1±560.3 | 1.00 (1.00–1.00) | 0.983 |
| Pre IV category | ||||
| Missing IV fluids | 21.5 | 20.5 | 0.94 (0.90–0.98) | 0.005 |
| No IV fluids | 64.5 | 65.3 | 1.03 (1.00–1.07) | 0.059 |
| 1 to 999 (mL) IV fluids | 6.4 | 6.6 | 1.04 (0.97–1.11) | 0.267 |
| 1000+ (mL) IV fluids | 7.6 | 7.6 | 1.00 (0.94–1.06) | 0.946 |
| Procedural characteristics | ||||
| Priority | ||||
| Elective | 62.7 | 47.6 | 0.55 (0.53–0.57) | <0.001 |
| Urgent | 33.5 | 42.6 | 1.46 (1.41–1.51) | <0.001 |
| Emergent | 3.7 | 9.4 | 2.65 (2.49–2.83) | <0.001 |
| Salvage | 0.1 | 0.4 | 8.73 (6.07–12.55) | <0.001 |
| Diagnostic cardiac catheterization | 86.1 | 92.3 | 1.94 (1.82–2.06) | <0.001 |
| Percutaneous coronary intervention | 45.7 | 25.6 | 0.41 (0.39–0.42) | <0.001 |
| Ad hoc PCI | 31.8 | 17.9 | 0.47 (0.45–0.49) | <0.001 |
| Multivessel disease | 4.4 | 3.3 | 0.75 (0.68–0.82) | <0.001 |
| Number of diseased vessels | 0.4±0.6 | 0.2±0.5 | 0.53 (0.51–0.55) | <0.001 |
| None | 63.5 | 80.0 | ||
| Single | 32.1 | 16.7 | ||
| Double | 4.1 | 2.9 | ||
| Triple | 0.3 | 0.4 | ||
| Number of diseased lesions | 0.5±0.8 | 0.3±0.7 | 0.65 (0.63–0.67) | <0.001 |
| None | 63.5 | 80.0 | ||
| One | 24.2 | 12.6 | ||
| Two | 9.0 | 5.3 | ||
| Three | 2.6 | 1.6 | ||
| Four | 0.6 | 0.4 | ||
| Five | 0.2 | 0.2 | ||
| Stent procedure | 38.6 | 20.4 | 0.41 (0.39–0.42) | <0.001 |
| Number of interventions | 1.7±2.6 | 1.0±2.3 | 0.88 (0.87–0.89) | <0.001 |
| Number of stents | 0.6±0.9 | 0.4±0.9 | 0.69 (0.67–0.71) | <0.001 |
| Intra‐aortic balloon pump | 0.8 | 5.7 | 7.21 (6.56–7.93) | <0.001 |
| Contrast type | ||||
| Hexabrix | 0.4 | 0.9 | 2.59 (2.14–3.13) | <0.001 |
| Isovue | 15.1 | 11.1 | 0.70 (0.67–0.74) | <0.001 |
| Omnipaque | 8.0 | 6.8 | 0.84 (0.79–0.90) | <0.001 |
| Other contrast | 2.1 | 1.9 | 0.88 (0.78–0.99) | 0.037 |
| Ultravist | 5.0 | 5.1 | 1.02 (0.95–1.10) | 0.553 |
| Unknown contrast | 31.3 | 32.9 | 1.08 (1.04–1.11) | <0.001 |
| Visipaque270 | 5.5 | 6.3 | 1.16 (1.08–1.24) | <0.001 |
| Visipaque320 | 24.4 | 23.0 | 0.93 (0.89–0.97) | <0.001 |
| Contrast volume, mL | 155.2±104.1 | 125.8±103.4 | 1.00 (1.00–1.00) | <0.001 |
| Contrast: GFR ratio33 | 2.1±1.7 | 2.1±2.5 | 1.01 (1.00–1.02) | 0.013 |
| Contrast GFR ratio >3 | 12.5 | 14.9 | 1.22 (1.16–1.28) | <0.001 |
ACE indicates angiotensin‐converting enzyme; AKI, acute kidney injury; AKIN, Acute Kidney Injury Network; ARB, angiotensin receptor blockers; ARF, acute renal failure; CABG, coronary artery bypass grafting; CHF, congestive heart failure; CIN, contrast‐induced nephropathy; CKD, chronic kidney disease; CKMB, creatinine kinase, muscle and brain subunits; eGFR, estimated glomerular filtration rate; ICD9, Current Procedural Terminology and International Statistical Classification of Diseases, 9th Revision; IV, intravenous; KDIGO, kidney disease improving global outcomes; MI, myocardial infarction; NSAIDS, nonsteroidal anti‐inflammatory drugs; OR, odds ratio; PCI, percutaneous coronary intervention.