Newsome BB et al. (2008) Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Arch Intern Med 168: 609–616

Small increases in serum creatinine level have been associated with an increased risk of adverse short-term outcomes in hospitalized patients, but do such increases correlate with long-term risk of end-stage renal disease (ESRD) and death? To answer this question, Newsome et al. performed a retrospective study of elderly survivors of hospitalization for acute myocardial infarction (AMI).

Data from 87,094 African American or white patients aged 65 years or older (mean age 77.1 years) who had been admitted for AMI to non-federal US hospitals during the period February 1994 to July 1995 were analyzed. Follow-up data until June 2004 were examined. History of ESRD before hospitalization and use of acute hemodialysis during hospitalization were exclusion criteria. The median duration of follow-up was 4.1 years. The study found that all quartiles of increase in serum creatinine level during hospitalization were associated with increases in the risk of ESRD and the risk of death after hospital discharge. The adjusted hazard ratios for increases in serum creatinine level relative to a decrease or no change ranged from 1.45 for ESRD and 1.14 for death in the first quartile (increase of 9 µmol/l [0.1 mg/dl]) to 3.26 and 1.39, respectively, in the fourth quartile (increase of 53–265 µmol/l [0.6–3.0 mg/dl]).

The authors conclude that elderly survivors of AMI who exhibit changes in serum creatinine level during hospitalization should be closely monitored and aggressively treated.