Impact of Malnutrition on Contrast-associated Acute Kidney Injury and follow-up mortality in Patients undergoing Coronary Angiography

Background Malnutrition is prevalent in patients with coronary disease. However, it’s unknown whether malnutrition would affect the risk of CA-AKI in patients undergoing coronary angiography(CAG). Methods We included patients with documented data for calculating controlling nutritional status(CONUT) score from a prospective multicenter cohort study(REICIN study) recruiting 4271 consecutive patients undergoing CAG(with or without percutaneous coronary intervention) from January 2013 to February 2016(NCT01402232). Patients were stratified as normal group(CONUT score 0-1), mild malnutrition group(CONUT score 2-4) and severe malnutrition group(CONUT score>4). CA-AKI was defined as an increase of serum creatinine level of >0.3 mg/d L or >50% within the first 48 hours since the procedure. The association of malnutrition and the risk of CA-AKI was examined by multivariable logistics regression analysis. 3862 patients undergoing CAG(median age: 63.1 ±10.7 years, 76.7% were male) were finally included in this study. Results Overall, 1769(45.8%) patients were complicated with mild malnutrition, 386(10.0%) were with severe malnutrition and 127(3.3%) patients eventually developed CA-AKI. The patients in severe malnutrition status were older, with worse cardiorenal function and had higher CA-AKI incidence than those without malnutrition. Adjusted multivariate logistic regression analysis demonstrated that mild malnutrition was 1.76-fold(95% CI 1.07-2.95) and the severe malnutrition was 2.77-fold(95%CI 1.41-5.37) higher risk of CA-AKI(all P<0.05, respectively) compared with patients in normal nutrition status.In addition, malnutrition level was also associated with an elevated risk of follow-up all-cause mortality(Log-Rank P<0.001). Conclusion Malnutrition is prevalent and associated with increased risk of CA-AKI among patients undergoing CAG.