Clinical analysis of 1 371 patients with acute kidney injury after acute myocardial infarction

Objective To investigate the risk factors of acute kidney injury (AKI) in patients after acute myocardial infarction (AMI). Methods A total of 1 371 adult patients diagnosed AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively. AKI was defined according to the 2012 KDIGO AKI criteria. Based on the occurrence of AKI, the patients were divided into AKI group and non-AKI group. According to the AKI timing, the patients were divided into subgroups including conservative treatment groups, coronary angiography(CAG) groups and coronary artery bypass grafting (CABG) groups, respectively. Related risk factors of AKI were analyzed by univariate and multivariate logistic regression. Results Of the 1 371 patients，410(29.9%) developed AKI. Compared to the non-AKI group, in-hospital mortality increased significantly in the AKI group (17.1% vs 3.9%, χ2=68.0, P＜0.001). Multifactor retrospective analysis showed that decreased baseline eGFR (OR=2.049, 95%CI: 1.246-3.370), increased fasting plasma glucose(FPG) (OR=1.070, 95%CI: 1.018-1.124), diuretics (OR=1.867, 95%CI: 1.220-2.856) and Killip class 4 status (OR=1.362, 95%CI: 1.059-3.170) were all independent risk factors of AKI, while increased DBP on admission was a protective factor (OR=0.986, 95%CI: 0.974-0.998) for the conservative management group. Decreased baseline eGFR (OR=2.371, 95%CI: 1.500-3.747), increased FPG(OR=1.009, 95%CI: 1.005-1.012), diuretics (OR=1.674, 95%CI: 1.042-2.690), intraoperative hypotension (OR=2.276, 95%CI: 1.324-3.575) and acute infection (OR=1.678, 95%CI: 1.023-2.754) were independent risk factors of AKI for the CAG group. Decreased baseline eGFR (OR=2.246, 95%CI:1.340-3.981), increased FPG (OR=1.059, 95%CI: 1.018-1.124), diuretics (OR=1.723, 95%CI: 1.122-2.650), and low cardiac output syndrome after operation (OR=2.331, 95%CI: 1.277-3.286) were independent risk factors of AKI for CABG group. Conclusions AKI is a common complication and associated with increased mortality after AMI. Decreased baseline renal function, increased FPG and diuretics were common independent risk factors of AKI after AMI.