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Association of acute kidney injury and chronic kidney disease with processes of care and long-term outcomes in patients with acute myocardial infarction.

Publication ,  Journal Article
Mody, P; Wang, T; McNamara, R; Das, S; Li, S; Chiswell, K; Tsai, T; Kumbhani, D; Wiviott, S; Goyal, A; Roe, M; de Lemos, JA
Published in: Eur Heart J Qual Care Clin Outcomes
January 1, 2018

AIMS: To examine the association of acute kidney injury (AKI) with long-term outcomes after myocardial infarction (MI), and evaluate whether effect modification is present according to baseline chronic kidney disease (CKD) status. METHODS AND RESULTS: ACTION Registry records from 2008 to 2012 were linked to Medicare claims data, creating a cohort of 76 500 acute MI patients aged ≥ 65 years who survived to hospital discharge. Mild, moderate, and severe AKI were defined as changes in creatinine from baseline to peak of 0.3 to < 0.5, 0.5 to < 1.0, and ≥ 1.0 mg/dL, respectively. Stage 3, Stage 4, and Stage 5 CKD were defined as estimated glomerular filtration rates of 30-59, 15-29, and <15 mL/min/m2, respectively. Cox proportional hazards modelling was used to examine associations of AKI with long-term outcomes. The prevalence of baseline CKD was: Stage 3 (41.2%), Stage 4 (6.7%), and Stage 5 (1.0%). The incidence of AKI was: mild (7.5%), moderate (6.0%), and severe (3.0%). A significant interaction of AKI with baseline CKD was observed for 1-year mortality (Pinteraction <0.001). Acute kidney injury was associated with worse multivariable-adjusted 1-year mortality among individuals without CKD: mild AKI [hazard ratio (HR): 1.33, 95% confidence interval (CI): 1.22-1.49], moderate AKI (HR:1.66, 95% CI: 1.46-1.89), and severe AKI (HR: 2.87, 95% CI: 2.41-3.43). An attenuation of this effect was noted with advancing stages of baseline CKD such that among patients with Stage 5 CKD, AKI was not associated with 1-year mortality. CONCLUSION: Acute kidney injury is associated with worse long-term outcomes after MI. This effect is modified by baseline CKD status.

Duke Scholars

Published In

Eur Heart J Qual Care Clin Outcomes

DOI

EISSN

2058-1742

Publication Date

January 1, 2018

Volume

4

Issue

1

Start / End Page

43 / 50

Location

England

Related Subject Headings

  • United States
  • Survival Rate
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Registries
  • Myocardial Infarction
  • Male
  • Incidence
  • Humans
  • Follow-Up Studies
 

Citation

APA
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ICMJE
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Mody, P., Wang, T., McNamara, R., Das, S., Li, S., Chiswell, K., … de Lemos, J. A. (2018). Association of acute kidney injury and chronic kidney disease with processes of care and long-term outcomes in patients with acute myocardial infarction. Eur Heart J Qual Care Clin Outcomes, 4(1), 43–50. https://doi.org/10.1093/ehjqcco/qcx020
Mody, Purav, Tracy Wang, Robert McNamara, Sandeep Das, Shuang Li, Karen Chiswell, Thomas Tsai, et al. “Association of acute kidney injury and chronic kidney disease with processes of care and long-term outcomes in patients with acute myocardial infarction.Eur Heart J Qual Care Clin Outcomes 4, no. 1 (January 1, 2018): 43–50. https://doi.org/10.1093/ehjqcco/qcx020.
Mody P, Wang T, McNamara R, Das S, Li S, Chiswell K, et al. Association of acute kidney injury and chronic kidney disease with processes of care and long-term outcomes in patients with acute myocardial infarction. Eur Heart J Qual Care Clin Outcomes. 2018 Jan 1;4(1):43–50.
Mody, Purav, et al. “Association of acute kidney injury and chronic kidney disease with processes of care and long-term outcomes in patients with acute myocardial infarction.Eur Heart J Qual Care Clin Outcomes, vol. 4, no. 1, Jan. 2018, pp. 43–50. Pubmed, doi:10.1093/ehjqcco/qcx020.
Mody P, Wang T, McNamara R, Das S, Li S, Chiswell K, Tsai T, Kumbhani D, Wiviott S, Goyal A, Roe M, de Lemos JA. Association of acute kidney injury and chronic kidney disease with processes of care and long-term outcomes in patients with acute myocardial infarction. Eur Heart J Qual Care Clin Outcomes. 2018 Jan 1;4(1):43–50.
Journal cover image

Published In

Eur Heart J Qual Care Clin Outcomes

DOI

EISSN

2058-1742

Publication Date

January 1, 2018

Volume

4

Issue

1

Start / End Page

43 / 50

Location

England

Related Subject Headings

  • United States
  • Survival Rate
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Registries
  • Myocardial Infarction
  • Male
  • Incidence
  • Humans
  • Follow-Up Studies