BACKGROUND Contrast-associated acute kidney injury (CA-AKI) associates with an increased relative risk for serious adverse outcomes. However, the magnitude of this risk and the incidence of clinically significant CA-AKI derived from analyses of large cohorts with prospective assessment of CA-AKI and subsequent outcomes are unknown. OBJECTIVES This study sought to characterize the relative risk for and incidence of serious adverse outcomes following the development of CA-AKI and to explore whether CA-AKI mediates the association of pre-angiography estimated glomerular filtration rate with adverse outcomes. METHODS Among 4,418 participants in the PRESERVE (Prevention of Serious Adverse Outcomes Following Angiography) trial with comprehensive baseline and outcome data, we assessed whether CA-AKI was associated with the 90-day outcome comprising death, need for dialysis, or persistent impairment in kidney function. We calculated the incidence of clinically significant CA-AKI (i.e., proportion of patients who developed CA-AKI and the 90-day outcome) and examined whether CA-AKI was a mediator of the association of baseline kidney function with the 90-day outcome. RESULTS CA-AKI was associated with an increased relative risk for 90-day death, need for dialysis, or persistent kidney impairment (odds ratio: 3.93; 95% confidence interval: 2.82 to 5.49; p < 0.0001). The incidence of clinically significant CA-AKI was 1.2% (53 of 4,418 patients). CA-AKI was not a mediator of the association of pre-angiography estimated glomerular filtration rate with the primary outcome. CONCLUSIONS Whereas CA-AKI is associated with an increased relative risk of serious, adverse 90-day outcomes, the incidence of clinically significant CA-AKI is very low. CA-AKI does not mediate the association of the pre-angiography estimated glomerular filtration rate with these outcomes.

中文翻译：

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造影剂相关的急性肾损伤和血管造影后的严重不良后果

背景 造影剂相关急性肾损伤 (CA-AKI) 与严重不良后果的相对风险增加有关。然而，这种风险的大小和临床显着 CA-AKI 的发生率是未知的，这些分析来源于对 CA-AKI 和后续结果的前瞻性评估的大型队列分析。目的 本研究旨在描述 CA-AKI 发生后严重不良结局的相对风险和发生率，并探讨 CA​​-AKI 是否介导了血管造影前估计的肾小球滤过率与不良结局之间的关联。方法 在具有全面基线和结果数据的 PRESERVE（预防血管造影后严重不良结果）试验的 4,418 名参与者中，我们评估了 CA-AKI 是否与包括死亡、需要透析，或肾功能持续受损。我们计算了具有临床意义的 CA-AKI 的发生率（即发生 CA-AKI 和 90 天结局的患者比例），并检查了 CA-AKI 是否是基线肾功能与 90 天结局相关的中介因素. 结果 CA-AKI 与 90 天死亡、需要透析或持续肾损伤的相对风险增加相关（优势比：3.93；95% 置信区间：2.82 至 5.49；p < 0.0001）。具有临床意义的 CA-AKI 的发生率为 1.2%（4,418 名患者中的 53 名）。CA-AKI 不是血管造影前估计的肾小球滤过率与主要结果之间关联的中介因素。结论 尽管 CA-AKI 与 90 天严重不良结局的相对风险增加有关，具有临床意义的 CA-AKI 的发生率非常低。CA-AKI 不会介导血管造影前估计的肾小球滤过率与这些结果之间的关联。