{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:34:38Z","timestamp":1787236478249,"version":"build-2736575974"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\u201cRenalism\u201d is a term defining the therapeutic nihilism that leads to patients with kidney disease waiting longer for effective interventions to reach them; in this context is also inscribed the reluctance of clinicians to conduct contrast-based studies such as left heart catheterization on individuals with chronic kidney disease (CKD). Non-ST-elevation myocardial infarction (NSTEMI) often requires left heart catheterization, and delay can lead to increased mortality and adverse cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The National Inpatient Sample Database 2016\u20132018 was used to sample patients presenting with NSTEMI. Baseline demographics and comorbidities were collected using ICD-10-codes. Patients below 18 years old, with missing data, and with kidney failure were excluded. Patients were stratified into CKD 1\u20132 vs CKD 3\u20135. 1:1 propensity score matching was performed to match the two cohorts. Mortality and cardiovascular outcomes were compared in patients with CKD 3\u20135 who underwent left heart catheterization and those who did not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 427 593 NSTEMI patients, 79 284 had CKD 3\u20135. CKD 3\u20135 patients were less likely to undergo left heart catheterization and had increased mortality. After matching, CKD 3\u20135 was independently associated with fewer left heart catheterizations. During regression analysis, CKD 3\u20135 patients that underwent left heart catheterization were 1.93 times less likely to have in-hospital mortality compared to patients that did not undergo left heart catheterization. Additionally, left heart catheterization in CKD 3\u20135 patients was also associated with decreased cardiovascular outcomes and acute kidney injury (AKI) (P &amp;lt; .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Alteration in practice-based guidelines due to the risk of contrast-associated acute kidney injury (CA-AKI) leads to less left heart catheterization in patients with CKD and increased mortality and adverse cardiovascular outcomes. Further studies are needed to evaluate the risks and benefits of contrast-based interventions in this patient cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajaf048","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T12:26:45Z","timestamp":1767702405000},"page":"751-757","source":"Crossref","is-referenced-by-count":0,"title":["Renalism: an obstacle to left heart catheterization in\u00a0chronic kidney disease patients"],"prefix":"10.1093","volume":"39","author":[{"given":"Ahmad","family":"Mustafa","sequence":"first","affiliation":[{"name":"Department of Cardiology, Staten Island University Hospital , Staten Island, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5806-9580","authenticated-orcid":false,"given":"Alaukika","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital , Staten Island, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chapman","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital , Staten Island, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Amor","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Staten Island University Hospital , Staten Island, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie","family":"El-Charabaty","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Staten Island University Hospital , Staten Island, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"El-Sayegh","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Staten Island University Hospital , Staten Island, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2026082009364553700_aajaf048-B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: an update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int Suppl (2011)."},{"key":"2026082009364553700_aajaf048-B2","doi-asserted-by":"publisher","first-page":"e342","DOI":"10.1016\/S2214-109X(24)00050-0","article-title":"Global burden of chronic kidney disease in 2019 and projections to 2040","volume":"12","author":"Jadoul","year":"2024","journal-title":"Lancet Glob Health."},{"key":"2026082009364553700_aajaf048-B3","volume-title":"StatPearls [Internet]","author":"Vaidya","year":"2026"},{"key":"2026082009364553700_aajaf048-B4","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1001\/jama.2019.14745","article-title":"Chronic kidney disease diagnosis and management: a review","volume":"322","author":"Chen","year":"2019","journal-title":"JAMA"},{"key":"2026082009364553700_aajaf048-B5","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1161\/CIR.0000000000000183","article-title":"Pharmacotherapy in chronic kidney disease patients presenting with acute coronary syndrome: a scientific statement from the American Heart Association","volume":"131(12)","author":"Washam","year":"2015","journal-title":"Circulation"},{"key":"2026082009364553700_aajaf048-B6","doi-asserted-by":"publisher","first-page":"e010394","DOI":"10.1161\/JAHA.118.010394","article-title":"Temporal trends in utilization of cardiac therapies and outcomes for myocardial infarction by degree of chronic kidney disease: a report from the NCDR chest pain-MI registry","volume":"7","author":"Bagai","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2026082009364553700_aajaf048-B7","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.numecd.2014.11.002","article-title":"Type of myocardial infarction presentation in patients with chronic kidney disease","volume":"25","author":"Ferrara","year":"2015","journal-title":"Nutr Metab Cardiovasc Dis."},{"key":"2026082009364553700_aajaf048-B8","doi-asserted-by":"publisher","first-page":"2462","DOI":"10.1097\/01.ASN.0000135969.33773.0B","article-title":"Renalism\u201d: inappropriately low rates of coronary angiography in elderly individuals with renal insufficiency","volume":"15","author":"Chertow","year":"2004","journal-title":"J Am Soc Nephrol."},{"key":"2026082009364553700_aajaf048-B9","doi-asserted-by":"publisher","first-page":"100438","DOI":"10.1016\/j.lanepe.2022.100438","article-title":"Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2\u00b74 million patients from 11 countries: the CaReMe CKD study","volume":"19","author":"Sundstr\u00f6m","year":"2022","journal-title":"Lancet Reg Health Eur"},{"key":"2026082009364553700_aajaf048-B10","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.ahj.2009.05.011","article-title":"Renal function, atherothrombosis extent, and outcomes in high-risk patients","volume":"158","author":"Dumaine","year":"2009","journal-title":"Am Heart J."},{"key":"2026082009364553700_aajaf048-B11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3390\/jcm9010004","article-title":"Chronic kidney disease has a graded association with death and cardiovascular outcomes in stable coronary artery disease: an analysis of 21,911 patients from the CLARIFY registry","volume":"9","author":"Vidal-Petiot","year":"2019","journal-title":"J Clin Med."},{"key":"2026082009364553700_aajaf048-B12","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1002\/cce2.57","article-title":"Management of patients with coronary artery disease and chronic kidney disease","volume":"3","author":"Lakkas","year":"2017","journal-title":"Continuing Cardiol Educ"},{"key":"2026082009364553700_aajaf048-B13","doi-asserted-by":"publisher","first-page":"1198560","DOI":"10.3389\/fneph.2023.1198560","article-title":"Pathophysiological concepts and screening of cardiovascular disease in dialysis patients","volume":"3","author":"Echefu","year":"2023","journal-title":"Front Nephrol."},{"key":"2026082009364553700_aajaf048-B14","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1161\/CIRCULATIONAHA.109.865352","article-title":"Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry","volume":"121","author":"Fox","year":"2010","journal-title":"Circulation"},{"key":"2026082009364553700_aajaf048-B15","volume-title":"StatPearls [Internet]","author":"Modi","year":"2026"},{"key":"2026082009364553700_aajaf048-B16","doi-asserted-by":"publisher","first-page":"728","DOI":"10.2214\/ajr.19.21309","article-title":"Contrast-induced acute kidney injury among patients with chronic kidney disease undergoing imaging studies: a meta-analysis","volume":"213","author":"Lee","year":"2019","journal-title":"AJR Am J Roentgenol."},{"key":"2026082009364553700_aajaf048-B17","volume-title":"StatPearls","author":"Modi","year":"2023"},{"key":"2026082009364553700_aajaf048-B18","doi-asserted-by":"publisher","first-page":"10","DOI":"10.15420\/icr.2008.3.1.10","article-title":"Contrast-induced nephropathy in a high-risk patient population","volume":"3","author":"Caixeta","year":"2008","journal-title":"Interventional Cardiol"},{"key":"2026082009364553700_aajaf048-B19","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1056\/NEJMoa1404881","article-title":"Management of coronary disease in patients with advanced kidney disease","volume":"372","author":"Bangalore","year":"2015","journal-title":"N Engl J Med."},{"key":"2026082009364553700_aajaf048-B20","doi-asserted-by":"publisher","first-page":"683","DOI":"10.3949\/ccjm.87a.20015","article-title":"Contrast media in patients with kidney disease: an update","volume":"87","author":"Mehdi","year":"2020","journal-title":"Cleve Clin J Med."},{"key":"2026082009364553700_aajaf048-B21","doi-asserted-by":"publisher","first-page":"2058460115583034","DOI":"10.1177\/2058460115583034","article-title":"Contrast-induced nephropathy in patients with chronic kidney disease and peripheral arterial disease","volume":"4","author":"Kroneberger","year":"2015","journal-title":"Acta Radiol Open."},{"key":"2026082009364553700_aajaf048-B22","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.iccl.2023.06.005","article-title":"Avoiding procedure, more harm than good?","volume":"12","author":"Adusumilli","year":"2023","journal-title":"Interv Cardiol Clin"},{"key":"2026082009364553700_aajaf048-B23","doi-asserted-by":"publisher","first-page":"100300","DOI":"10.1016\/j.ahjo.2023.100300","article-title":"Underutilization of left heart catheterization in kidney transplant patients presenting with non-ST segment elevation myocardial infarction","volume":"30","author":"Mustafa","year":"2023","journal-title":"Am Heart J Plus."},{"key":"2026082009364553700_aajaf048-B24","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1016\/j.jacc.2004.06.068","article-title":"A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation","volume":"44","author":"Mehran","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2026082009364553700_aajaf048-B25","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.ijcard.2016.12.095","article-title":"A novel risk score model for prediction of contrast-induced nephropathy after emergent percutaneous coronary intervention","volume":"230","author":"Lin","year":"2017","journal-title":"Int J Cardiol"},{"key":"2026082009364553700_aajaf048-B26","doi-asserted-by":"publisher","first-page":"337","DOI":"10.34067\/KID.0000000686","article-title":"Gastrointestinal bleeding in patients with CKD: the renalism continues!","volume":"6","author":"Elrggal","year":"2025","journal-title":"Kidney360"}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/4\/751\/68535559\/aajaf048.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/4\/751\/68535559\/aajaf048.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:37:00Z","timestamp":1787233020000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/article\/39\/4\/751\/8709041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,8,20]]}},"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajaf048","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,5]]}}}