Total cholesterol as an independent risk factor for contrast-induced acute kidney injury in patients undergoing coronary angiography

Background: Identifying high-risk patients based on risk factors is crucial for targeted prevention and management strategies. This study investigated the relationship between total cholesterol (TC) and contrast-induced acute kidney injury (CI-AKI). Methods: This multicenter retrospective study analyzed patients undergoing coronary angiography at five tertiary hospitals in China between January 2007 and December 2021. Univariate and multivariate logistic regression models were employed to investigate the association between total cholesterol levels and contrast-induced acute kidney injury (CI-AKI). Based on international diagnostic criteria, CI-AKI was defined as either an absolute elevation of serum creatinine (SCr) ≥0.5 mg/dL or a relative increase ≥25% from baseline values within 48–72 hours following intravenous contrast administration. Results: A total of 38,938 patients (mean age 63.1 ± 11.4 years, 71.6% male) were included in this study. The analysis revealed a progressive elevation in CI-AKI incidence across cholesterol quartiles, with rates of 10.7% (Q1), 10.7% (Q2), 12.2% (Q3) and 13.6% (Q4). Among 4587 documented CI-AKI cases (11.7% prevalence), serum total cholesterol concentrations were significantly elevated compared to non-CI-AKI counterparts (4.7 ± 1.2 vs. 4.6 ± 1.1 mmol/L, p < 0.001). Multivariable adjustment confirmed total cholesterol as an independent predictor for CI-AKI development (odds ratio (OR), 1.103, 95% confidence interval (CI), 1.072–1.135, p < 0.001). Conclusions: The measurement of plasma TC concentration in patients undergoing Coronary Angiography (CAG) may serve as a valuable tool for identifying individuals at risk of CI-AKI, thus representing a novel and significant risk factor for CI-AKI.

Contrast-induced acute kidney injury; Total cholesterol; Coronary angiography

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