Racial Disparity in Likelihood of AKI Following PCI

Patients undergoing percutaneous coronary intervention (PCI) are at risk for acute kidney injury (AKI). There are few available data quantifying racial differences in the incidence of AKI following PCI. Joseph Lunyera, MBChB, and colleagues conducted an analysis to examine the association between self-reported race and baseline estimated glomerular filtration rate (eGFR) with the incidence of AKI at a single center between January 1, 2003, and December 31, 2013.

Results of the analysis were reported during a virtual poster session at ASN Kidney Week 2020. The poster was titled Racial Differences in AKI Following Percutaneous Coronary Intervention.

Patients who underwent PCI at Duke University School of Medicine, Durham, North Carolina, self-reported their race as Black, White, or other. Data were gathered in the Duke Databank for Cardiovascular Disease. AKI was defined as ≥1.5-fold increase in serum creatinine from outpatient reference value prior to PCI to the peak value within 7 days following PCI or a 0.3 mg/dL increase from the reference value within 48 hours.

The researchers utilized logistic regression adjusted for demographics, comorbidities, predisposing medications (nonsteroidal anti-inflammatory drugs, renin-angiotensin-aldosterone system inhibitors, diuretics), PCI indication (presenting with vs without acute coronary syndrome), peri-procedural prophylaxis with intravenous fluids and n-acetylcysteine, urgency of PCI, and blood pressure at the time of PCI.

The cohort included 9422 patients; median age was 63 years, 33% were female, 75% were White, 20% were Black, and 5% were other race. Nine percent of the total cohort developed AKI: 14% of Blacks, 8% of Whites, and 10% in other race groups.

Following adjustment, there was an association between Black race and greater likelihood of AKI: odds ratio (OR), in Black (vs White) patients, was 1.80 (95% confidence interval [CI], 1.49-2.18). Compared with White patients, there was no association between AKI and other race (OR, 1.31; 95% CI, 0.91-1.87). There was an association between low baseline eGFR and graded, higher likelihood of AKI: P for trend <.001. There was no interaction between race and baseline eGFR.

“Black patients had nearly twice the likelihood for AKI following PCI than Whites despite adjustment for baseline kidney function, prophylaxis, and procedural characteristics. Future investigations should identify other factors that predispose Black individuals to disparate AKI risk following PCI,” the researchers said.

Read more here: https://www.asn-online.org/education/kidneyweek/2020/program-abstract.aspx?controlId=3445284

Source: Lunyera J, Clare RM, Chiswell K, et al. Racial differences in AKI following percutaneous coronary intervention. Abstract of a poster presented at the American Society of Nephrology virtual Kidney Week 2020 (PO0017), October 22, 2020.