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Clinical Epidemiology
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Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention

Joseph Lunyera, Robert M. Clare, Karen Chiswell, Julia J. Scialla, Patrick H. Pun, Kevin L. Thomas, Monique A. Starks and Clarissa J. Diamantidis
JASN March 2021, 32 (3) 654-662; DOI: https://doi.org/10.1681/ASN.2020040502
Joseph Lunyera
1Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Robert M. Clare
2Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Karen Chiswell
2Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Julia J. Scialla
3Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
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Patrick H. Pun
2Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
4Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Kevin L. Thomas
2Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
5Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Monique A. Starks
2Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
5Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Clarissa J. Diamantidis
1Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
4Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
6Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
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Significance Statement

Percutaneous coronary intervention is linked with greater risk of AKI incidence; however, differences in this link by race remain less clear. This study quantified the association of race (White, Black, or other) with odds for AKI incidence within 7 days after percutaneous coronary intervention. After adjustment for demographics, comorbidities, medications, and procedural characteristics, the study found that, compared with Whites, odds for AKI incidence were substantially greater among Black but not other patients. Racial difference in odds for AKI incidence after percutaneous coronary intervention did not differ by baseline kidney function. These findings highlight the need to investigate factors that predispose Black individuals to greater risk for AKI after percutaneous coronary intervention.

Abstract

Background Undergoing percutaneous coronary intervention (PCI) is a risk factor for AKI development, but few studies have quantified racial differences in AKI incidence after this procedure.

Methods We examined the association of self-reported race (Black, White, or other) and baseline eGFR with AKI incidence among patients who underwent PCI at Duke University Medical Center between January 1, 2003, and December 31, 2013. We defined AKI as a 0.3 mg/dl absolute increase in serum creatinine within 48 hours, or ≥1.5-fold relative elevation within 7 days post-PCI from the reference value ascertained within 30 days before PCI.

Results Of 9422 patients in the analytic cohort (median age 63 years; 33% female; 75% White, 20% Black, 5% other race), 9% developed AKI overall (14% of Black, 8% of White, 10% of others). After adjustment for demographics, socioeconomic status, comorbidities, predisposing medications, PCI indication, periprocedural AKI prophylaxis, and PCI procedural characteristics, Black race was associated with increased odds for incident AKI compared with White race (odds ratio [OR], 1.79; 95% confidence interval [95% CI], 1.48 to 2.15). Compared with Whites, odds for incident AKI were not significantly higher in other patients (OR, 1.30; 95% CI, 0.93 to 1.83). Low baseline eGFR was associated with graded, higher odds of AKI incidence (P value for trend <0.001); however, there was no interaction between race and baseline eGFR on odds for incident AKI (P value for interaction = 0.75).

Conclusions Black patients had greater odds of developing AKI after PCI compared with White patients. Future investigations should identify factors, including multiple domains of social determinants, that predispose Black individuals to disparate AKI risk after PCI.

  • acute kidney injury
  • African Americans
  • racial disparities
  • percutaneous coronary intervention
  • Copyright © 2021 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 32 (3)
Journal of the American Society of Nephrology
Vol. 32, Issue 3
March 2021
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Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention
Joseph Lunyera, Robert M. Clare, Karen Chiswell, Julia J. Scialla, Patrick H. Pun, Kevin L. Thomas, Monique A. Starks, Clarissa J. Diamantidis
JASN Mar 2021, 32 (3) 654-662; DOI: 10.1681/ASN.2020040502

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Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention
Joseph Lunyera, Robert M. Clare, Karen Chiswell, Julia J. Scialla, Patrick H. Pun, Kevin L. Thomas, Monique A. Starks, Clarissa J. Diamantidis
JASN Mar 2021, 32 (3) 654-662; DOI: 10.1681/ASN.2020040502
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Keywords

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  • African Americans
  • racial disparities
  • percutaneous coronary intervention

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