Clinical risk factors for the prediction of acute kidney injury post cardiac resynchronization therapy in an elderly population.
Background
Data on the occurrence of acute kidney injury (AKI) in patients undergoing cardiac resynchronization therapy (CRT) implantation is limited and no previous studies investigated its impact in an elderly population. CRT implantation requires a relatively low quantity of contrast medium. Previous studies, however, focused primarily on contrast medium as etiological factor for AKI, reporting a high incidence (8-14%). The high incidence of AKI in absence of use of substantial amounts of contrast volume, suggests the existence of other factors that contribute to AKI.


Objectives
To determine the predictive value of patient and procedure-related risk factors for the occurrence of AKI post CRT, as well as the AKIs impact on length of in-hospital stay (LOS) and 1-year mortality.


Methods
Retrospective observational study, including consecutive patients that underwent CRT implantation in a single center.


Results
60 patients with a mean age of 77 ± 8.4 years were included in the study and Twelve (20%) developed AKI. Prior renal insufficiency (p = 0.03; OR = 15.4), larger procedure time (p = 0.02; OR = 1.03), intra-operative hypotension (p < 0.01; OR = 1.72) and bleeding (p = 0.01 (OR = 7.86), showed to predict AKI significantly. AKI associated a significantly longer LOS (12 vs 3 days, p < 0.01). No significant differences regarding 1-year mortality were observed (p = 0.19; HR = 2.7 for patients with AKI).


Conclusions
AKI is a frequent complication of CRT implantation with an important impact on in-hospital stay, especially in the elderly. In addition to contrast administration, clinical factors could play a significant role in the occurrence of AKI.
['Marschall|Alexander|A|', 'Del Castillo Carnevalli|Hugo|H|', 'De la Flor Merino|José Carlos|JC|', 'Rubio Alonso|Miguel|M|', 'De Miguel Gómez|Ramón|R|', 'Palazuelos Molinero|Jorge|J|', 'Goncalves Sánchez|María de Fatima|MF|', 'López Soberon|Edurne|E|', 'Fernández Pascual|Concepción|C|', 'Concepción Suárez|Ricardo|R|', 'Carballeira Puentes|Dámaris|D|', 'Delgado Calva|Freddy Andrés|FA|', 'Álvarez Antón|Salvador|S|', 'Martí Sánchez|David|D|']
Acute kidney injury Cardiac resynchronization therapy Incidence Predictors