Long-term outcomes after acute kidney injury in myocardial infarction complicated by cardiogenic shock - a retrospective, observational study.

Abstract

Background: The recent DanGer shock trial found reduced mortality, but increased risk of acute kidney injury (AKI) in patients treated with a microaxial flow pump after an acute myocardial infarct with cardiogenic shock. AKI has previously been associated with increased short-term mortality, whereas data on long-term outcomes are sparse. We aimed to describe the frequency of AKI and associated risk factors as well as long-term mortality and morbidity.

Methods: A retrospective observational study comprising patients admitted with acute myocardial infarction cardiogenic shock in Denmark between 2010-2017 with data on kidney function from the RETROSHOCK cohort. National health registry data enabled 10-year follow-up to assess mortality and morbidity. Kaplan-Meier estimates and competing risks regression were used to evaluate the association of AKI with the incidence of short- and long-term mortality, chronic kidney disease and dialysis.

Results: Among 1473 patients, 44% developed acute kidney injury, 25% required renal replacement therapy. AKI development was associated with increasing age, diabetes, low ejection fraction and high lactate levels on admission (p<0.05).30-days mortality as well as mortality at 1-, 5- and 10-years follow-up was significantly increased in patients with AKI; at 10 years follow-up mortality was increased by more than 30% (p<0.001). The 10-year cumulative incidence of both chronic kidney disease and dialysis, accounting for the competing risk of death, was significantly higher in patients treated with RRT during admission (p< 0.001).

Conclusions: Acute kidney injury was associated with increased short- and long-term mortality and morbidity, including chronic kidney disease and dialysis, but not new cardiovascular events.