Colchicine use after acute myocardial infarction is associated with reduced dialysis dependence in advanced chronic kidney disease

Abstract

Abstract Evidence-based treatments to improve renal outcomes in patients with advanced chronic kidney disease (CKD) after acute myocardial infarction (AMI) are limited. We aimed to evaluate the clinical effects of colchicine therapy after AMI in these patients. This retrospective cohort study used data from the TriNetX US Collaborative Network and included adults with an estimated glomerular filtration rate ≤ 45 mL/min/1.73 m 2 who were newly diagnosed with AMI between January 1, 2012, and December 31, 2022. Patients were grouped by colchicine use within 1 month after AMI and matched 1:1 by propensity score (n = 1,200 per group). Cox proportional-hazards and Kaplan–Meier analyses assessed outcomes. The primary outcome was dialysis dependence; secondary outcomes included major adverse cardiac events (MACE) and mortality. A landmark analysis was conducted for different colchicine initiation times after AMI. Over a maximum follow-up period of 4 years, colchicine use within one month was associated with reduced risks of dialysis dependence (hazard ratio (HR), 0.65; 95% confidence interval (CI) 0.53–0.79) compared to non-use. However, no significant between-group difference was observed in the risk of MACE (HR 1.04; 95% CI 0.94–1.15) and all-cause mortality (HR 1.03; 95% CI 0.87–1.22). These results were consistent in the landmark analysis. Notably, initiation of colchicine within two weeks was associated with a lower risk of all-cause mortality (HR 0.85; 95% CI 0.73–0.99) in landmark analyses. In patients with advanced CKD experiencing AMI, early colchicine therapy may reduce the risks of dialysis dependence. Any potential survival benefit remains uncertain and should be confirmed in prospective studies.