Renal replacement therapy in acute coronary syndrome: what kind of patient requires it and what is its prognostic impact?

Type of funding sources: None.

The clinical acuity and medical complexity in contemporary tertiary center Cardiology Critical Care Units (CCCU) have heralded an increase in the prevalence of acute and chronic kidney disease. Consequently, renal replacement therapy (RRT) has become a rising technique in these units.

Our aim was to analyze the baseline characteristics, complications and prognosis of patients with acute coronary syndrome (ACS) who required RRT during their admission, and to compare them with the characteristics of those patients who did not.

Retrospective observational analysis of registered ACS patients admitted to the CCCU of a tertiary center between January 2011 and January 2021. A comparative analysis was performed between those patients who required RRT during their admission, either due to chronic kidney disease (CKD) or peri-infarct acute kidney injury, and the remaining patients.

2596 patients were included in the analysis, showing the baseline characteristics listed in the table. A total of 53 (2%) required RRT during their admission. Patients requiring RRT more frequently presented ACS without ST elevation (69.8% vs 37.9%; p <0.001), multivessel disease (41.3% vs 17%; p <0.001) and a III or IV Killip-Kimbal (KK) score (38.5% vs 11%; p <0.001). During admission, they had a higher incidence of atrial fibrillation (AF) (34% vs 13.3%; p <0.001), bleeding (26.4% vs 10.5%; p <0.001), stroke (5.7% vs 1.2%; p 0.004), peri-infarct cardiorespiratory arrest (20.8% vs 10.2%; p 0.013) and in-hospital death (34% vs 5.9%; p <0.001). In the multivariate analysis performed, RRT was not an independent predictor of mortality when corrected for other risk factors (diabetes mellitus, GRACE and CRUSADE scores, STEACS, single vessel disease, or KK score on admission).

Patients admitted with ACS who required RRT had a higher risk profile, with a worse in-hospital prognosis and a higher incidence of complications. However, RRT was not found to be an independent predictor of mortality after adjusting for other variables.