Renalism: an obstacle to left heart catheterization in chronic kidney disease patients.

BACKGROUND

"Renalism" is a term defining the therapeutic nihilism that leads to patients with kidney disease waiting longer for effective interventions to reach them; in this context is also inscribed the reluctance of clinicians to conduct contrast-based studies such as left heart catheterization on individuals with chronic kidney disease (CKD). Non-ST-elevation myocardial infarction (NSTEMI) often requires left heart catheterization, and delay can lead to increased mortality and adverse cardiovascular outcomes.

METHODS

The National Inpatient Sample Database 2016-2018 was used to sample patients presenting with NSTEMI. Baseline demographics and comorbidities were collected using ICD-10-codes. Patients below 18 years old, with missing data, and with kidney failure were excluded. Patients were stratified into CKD 1-2 vs CKD 3-5. 1:1 propensity score matching was performed to match the two cohorts. Mortality and cardiovascular outcomes were compared in patients with CKD 3-5 who underwent left heart catheterization and those who did not.

RESULTS

Of 427 593 NSTEMI patients, 79 284 had CKD 3-5. CKD 3-5 patients were less likely to undergo left heart catheterization and had increased mortality. After matching, CKD 3-5 was independently associated with fewer left heart catheterizations. During regression analysis, CKD 3-5 patients that underwent left heart catheterization were 1.93 times less likely to have in-hospital mortality compared to patients that did not undergo left heart catheterization. Additionally, left heart catheterization in CKD 3-5 patients was also associated with decreased cardiovascular outcomes and acute kidney injury (AKI) (P < .001).

CONCLUSION

Alteration in practice-based guidelines due to the risk of contrast-associated acute kidney injury (CA-AKI) leads to less left heart catheterization in patients with CKD and increased mortality and adverse cardiovascular outcomes. Further studies are needed to evaluate the risks and benefits of contrast-based interventions in this patient cohort.