• Tomonori Kimura, Yoshitsugu Obi, Keiko Yasuda, Ko-ichi Sasaki, Yoshihiro Takeda, Yoshiyuki Nagai, Enyu Imai, Hiromi Rakugi, Yoshitaka Isaka, and Terumasa Hayashi.
• Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 585-0871, Japan.
• Nephrol. Dial. Transplant. 2011 Jun 1; 26 (6): 1838-46.

BackgroundBoth chronic kidney disease (CKD) and post-angiographic acute kidney injury (AKI) are regarded as risks factors for long-term mortality after coronary angiography. On the other hand, acute haemodynamic disturbances requiring haemodynamic support have a strong impact on both the incidence of AKI and on prognosis after coronary angiography. The aim of this study was to determine the impact of CKD and AKI on long-term prognosis after coronary angiography among hospital survivors and to determine relationships with haemodynamic variables.MethodsWe studied 2439 patients who underwent coronary angiography or percutaneous coronary intervention. Relationships between both CKD and AKI and mortality or cardiovascular diseases were measured using unadjusted and adjusted Cox models for case-mix and laboratory variables.ResultsMultivariable Cox regression analysis identified CKD as an independent predictor of long-term mortality [adjusted hazard ratio (AHR) 1.51; 95% confidence interval (95% CI) 1.07-2.13] and composite end points (AHR 1.72; 95% CI 1.40-2.11). Lower estimated glomerular filtration ratio levels below 50 mL/min/1.73 m(2) were significantly associated with mortality after adjustments. A similar association was found even in haemodynamically stable patients. AKI was also a predictor of long-term composite end points (AHR 1.64; 95% CI 1.09-2.46); however, its impact was attenuated in haemodynamically stable patients.ConclusionsAmong hospital survivors, CKD is an independent predictor for both long-term mortality and composite end points, regardless of haemodynamic conditions. AKI is also a predictor of long-term prognosis; however, its impact may be attenuated in haemodynamically stable hospital survivors.

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