Hyperuricemia and high urinary uric acid levels are the new early predictors of contrast-associated acute kidney injury

Abstract Background and Aims Contrast associated acute kidney injury (CA-AKI) is recently evidenced with lower frequency although yet worldwide its incidence ranges from 0-24%. Recent studies and meta-analysis have reported that hyperuricemia seem to be a useful biomarker in the early prediction of CIN incidence. The role of urine PH and spot uric acid to creatinine ratio (UACR) provide controversial evidence on the occurrence of CA-AKI. This research aims to gather evidence on the effect of uricemia, urine PH and UACR on the development of CA-AKI in acute conditions like primary percutaneous coronary interventions (PCI). Method A sample of 100 patients who underwent emergency coronary angiography in Cardiology Intensive Care Unit/UHCN-Tirana/Albania from October 2021- March 2022 were enrolled. Among these patients CA-AKI incidence was monitored, while CA-AKI was defined as an increased creatinine levels of more 25% of the baseline in a time window of 48-72h after the contrast. The analyses of the results were performed using ANOVA test for differences in parameters among CA-AKI/Non – CA-AKI patients. In order to understand the effect of each factor on the probability of experiencing CA-AKI a binary logistic regression model was constructed. Statistical analyses were performed using R-software. Results The general incidence of CA-AKI is 40%, while being different for men and women, with men incidence being 60%. The mean age for the patients observed was age 64.7 years old. The ANOVA analyses showed that incidence of patients experiencing CA-AKI is significantly different for chronic kidney disease patients (p (0.001, OR = 32.67 (95%CL 9.65-110.55), patients with diabetes (P 0.0033, OR = 4.64 (95%Cl 1.69-12.68) and hypertension (p 0.055, OR = 7.80 (95%Cl 0.96-63.56). The binary logistic regression showed that probability to experience CIN is significantly impacted by UACR post contrast model 1 :3.123 (2,385) with marginal effect 22.72, BMI index model 1: (−0.850) 0.25 with marginal effect 1.28, Uricemia model 1: (1,128) 0.52 with marginal effect 1.68 and Natremia level before contrast model 1: (−1,831) 0.0011 with marginal effect 7.81. Statistical significance for these results is 99% (as manifested by p-value). Conclusion CA-AKI post PCI is still the Achilles Heel of interventional cardiology. The results confirm that the increase of uricemia and BMI doubles the risk for CA-AKI. Uricemia is confirmed as an important prognostic factor for development of CA-AKI. High urinary uric acid levels post contrast define UACR independent early risk factor for CA-AKI.