Contrast-associated acute kidney injury in patients with arterial hypertension and coronary artery disease and its long-term prognosis

Background. Arterial hypertension (AH) is frequently associated with coronary artery disease (CAD), especially in older patients and patients with comorbidities. Kidneys eliminate the contrast media after percutaneous coronary interventions and are considered target organs of AH, what makes the research of contrast-associated acute kidney injury (CA-AKI) and its long-term prognosis important topics for the researchers nowadays. Aim. To assess the incidence of CA-AKI in patients with CAD and AH and its prognostic significance. Materials and methods. 435 patients with stable CAD and AH and indications for studies with intraarterial iodine contrast media administration were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153) with a follow-up period more than 5 years. CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was CI-AKI according to KDIGO criteria. The secondary endpoints were total mortality, cardiovascular mortality, myocardial infarction, stroke, acute decompensation of heart failure, coronary artery bypass grafting, repeat percutaneous coronary intervention. Results. Most of the patients, included in the study, were overweight (BMI 29.1±4.8 kg/m2) males. 88 (20.2%) patients suffered from diabetes mellitus and 3.9% had heart failure. The mean volume of contrast media administered was 236.6±90.2 ml. The rate of CA-AKI was 82 (18.9%) cases. The cardiovascular mortality rate was 3.9%, myocardial infarction - 9.4%, stroke - 2.5%, acute decompensation of heart failure - 9.7%. Conclusion. The rate of CA-AKI in patients with stable CAD and AH is slightly higher than in patients without such a combination of diseases. There is a trend towards better survival free of myocardial infarction, stroke or acute decompensation of heart failure in patients without CA-AKI.

contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, coronary artery disease, percutaneous coronary intervention, arterial hypertension, stable coronary artery disease, prognosis

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