ACUTE kidney injury (AKI) requiring dialysis occurred in 0.6% of patients following percutaneous coronary intervention (PCI) and was strongly associated with high in-hospital mortality and adverse cardiovascular outcomes.
AKI is a serious, life-threatening complication that can occur after PCI, a common treatment for coronary artery disease. While advances in practice have reduced many risks, patients developing AKI severe enough to require dialysis continue to present significant clinical management challenges, with uncertain prognosis. Understanding the profile of these patients and their outcomes is vital to improving prevention and post-procedural care.
The PROGRESS-COMPLICATIONS registry study analysed 18,691 consecutive PCI patients treated between 2016 and 2023. Of these, 119 (0.6%) developed AKI necessitating dialysis. The cohort was predominantly older (mean age 71 years), mostly male (58.8%), and carried heavy comorbidity burdens, including diabetes (38.7%), pre-existing chronic kidney disease (73.9%), hypertension (84%), heart failure (67.8%), and previous myocardial infarction (54%). Most presented with acute coronary syndrome (94.9%), and substantial numbers had pre-procedural cardiac arrest (23.5%) or cardiogenic shock (11.7%). Anatomically, the left anterior descending artery (44.2%) and complex lesions featuring bifurcation (37%) and moderate-to-severe calcification (53.5%) were frequent challenges. Patients received a median contrast load of 130 mL. Technical success was achieved in 73.9% of cases, but in-hospital mortality was strikingly high at 48.7%. Major complications, including hypotension (43.7%) and bleeding (30.3%), were common. Median hospital stay was prolonged at 11 days. During a median follow-up of 35 days, the incidence of major adverse cardiovascular events reached 63.6%, largely driven by a 62.1% mortality rate.
These findings highlight that while AKI requiring dialysis post-PCI is relatively rare, it identifies an exceptionally high-risk population with poor short- and medium-term prognosis. For clinical practice, rigorous identification and risk stratification of susceptible patients, particularly those with significant comorbidities or presenting with acute coronary events, is imperative. Enhanced multidisciplinary care, early nephrology involvement, and close follow-up may help mitigate risk and support recovery in this vulnerable group.
Reference
Mutlu D et al. Acute kidney injury requiring dialysis following percutaneous coronary intervention: insights from the PROGRESS‐COMPLICATIONS registry. Catheterization and Cardiovascular Interventions. 2025;DOI:10.1002/ccd.70012.
