A patient with chronic kidney disease and postcontrast acute kidney injury may experience progressive kidney disease. Baek et al reported a model for identifying a patient at risk for progression of the kidney disease. The authors are from Mideplex Sejong Hospital, Dankook University, Sejong General Hospital, Asan Medical Center and University of Ulsan in South Korea.
Patient selection: postcontrast acute kidney injury in a patient with chronic kidney disease (eGFR less than 60 mL per min per 1.73 square meters)
Outcome: renal disease progression (reduction in eGFR >= 25% from baseline at 1 year)
Parameters:
(1) diabetes
(2) baseline eGFR in mL per min per 1.73 sq meters
(3) hypertension
(4) repeat contrast exposure
(5) congestive heart failure
(6) persistent renal injury (>= 25% elevation of serum creatinine at 3 months)
Parameter
Finding
Points
diabetes
no
0
yes
4
baseline eGFR
>= 45
0
< 45
4
hypertension
no
0
yes
6
repeat contrast exposure
no
0
yes
6
congestive heart failure
no
0
yes
7
persistent kidney injury
no
0
yes
6
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 33
• The higher the score the greater the risk of renal deterioration.
Total Score
Risk Group
0 to 7
low
8 to 14
moderate
15 to 21
high
>= 22
very high
Performance:
• The area under the ROC curve was 0.77 in the development and 0.65 in the validation cohort.
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