Trends in Acute Kidney Injury in Patients With Acute Myocardial Infarction

Among patients hospitalized with an acute myocardial infarction (AMI), about 20% will develop an acute kidney injury (AKI). This complication has been linked to adverse long-term outcomes, including permanent renal impairment and end-stage renal disease. Minor increases in serum creatinine levels have also been associated with increased mortality, longer hospitalizations, and higher costs. “Experts are increasingly emphasizing the importance of preventing AKI and promptly recognizing it in patients hospitalized with AMI,” says Mikhail N. Kosiborod, MD. “A better understanding of trends may help determine if recent prevention efforts have been successful. This data can also be used to form initiatives aimed at preventing AKI.” Taking a Closer Look at AKI In the February 13, 2012 Archives of Internal Medicine, Dr. Kosiborod and colleagues analyzed data from a registry of patients admitted to 56 hospitals across the United States to examine trends in AKI from 2000 to 2008. AKI was defined as an increase of at least 0.3 mg/dL in creatinine levels or a relative increase of at least 50% during hospitalization. “The database used in our analysis had an extensive collection of laboratory data, including detailed assessments of renal function,” says Dr. Kosiborod. “Using this information, we wanted to understand the incidence trends in AKI and use of AKI prevention strategies among patients hospitalized with AMI.” According to findings, the incidence of AKI declined from 26.6% in 2000 to 19.7% in 2008 (Figure). In-hospital mortality also declined in patients who developed AKI, dropping from 19.9% in 2000 to 13.8% in 2008. This improvement occurred despite a concomitant increase in AKI risk factors, including chronic kidney disease, cardiogenic shock, diabetes,...