Biomarker response to contrast administration in diabetic and nondiabetic patients following coronary angiography

Abstract

Neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C represent early renal injury markers for contrast-induced nephropathy (CIN). Baseline parameters such as type and quantity of contrast, patient preparation, renal function status, and diabetes mellitus (DM) are known to affect the response of the kidney to contrast-induced injury. This study was taken up to know the biomarker response to contrast administration in 58 diabetic and 59 nondiabetic male patients with same baseline parameters and baseline serum creatinine <1.2 mg/dl undergoing coronary angiography and their role in predicting the development of CIN. Serum creatinine, serum cystatin C, and urinary-NGAL (u-NGAL) were analyzed at baseline (0 h), 4 h, and 24 h after the administration of contrast medium. CIN was defined as a 25% increase in serum creatinine concentration from the baseline value or an absolute increase of at least 0.5 mg/dl within 48 h after the administration of contrast media. Serum creatinine rose 24 h after contrast administration in the diabetic group compared to 48 h in the nondiabetic group. Serum cystatin C levels rose 24 h after contrast administration in both the groups. The earliest marker to rise in both the groups was u-NGAL at 4 h. Diabetic patients had significantly higher u-NGAL (P = 0.005), and serum creatinine levels (P = 0.008) 4 h, and 24 h after contrast administration, respectively. Serum creatinine and u-NGAL/creatinine at 4 h were found to be the best predictors of CIN in the DM and non-DM patients, respectively. Biomarker response to contrast administration is different in diabetic and nondiabetic patients following contrast administration. Diabetic patients exhibit early and greater degree of renal impairment compared to the nondiabetic patients irrespective of the outcome. We propose the use of serum creatinine in patients with DM and u-NGAL/creatinine in non-DM patients to identify CIN as early as 4 h after contrast administration.

NGAL as Biomarker of Clinical and Subclinical Damage of Kidney Function after Coronary Angiography

“…In our study, patients with a high risk profile (arterial hypertension, dyslipidemia, DM type 2 in >90% of patients) and a high ischemic burden with clinically manifested or proven coronary heart disease (stable angina pectoris > 85%, history of MI, previous PCI or ACB revascularization > 48% of all patients) were enrolled. The frequency of CI-AKI was found to be 26.7%, which is close to the 24.1% reported in the literature in a cohort of patients with type 2 diabetes mellitus [ 45 ].…”

“…In the literature, there is no clear definition of subclinical CI-AKI or a clearly defined frequency of this group of events. Initially, some authors [ 45 ] only describe that among the group “without CIN”, there are individuals with an increase in NGAL similar to that reported in CIN. On the other hand, other studies [ 51 , 59 ] suggest a limit, such as an increase of >25% of the biomarker, or assume that for the diagnosis of subclinical AKI, the biomarker must increase by two times compared to its baseline levels [ 52 , 60 ].…”

“…Furthermore, our selected cohort of patients with predominant diabetes mellitus type 2 (91.1%) was completely different from most studies [ 17 , 27 , 31 , 32 , 54 , 55 , 56 , 57 ], where the incidence of DM was between 14% and 34%. From this perspective, the only study reporting the role of NGAL exclusively in diabetic patients is presented by Ashalatha et al [ 45 ], and its results showed that serum creatinine and NGAL increased significantly as early as the 4th hour, and a difference (when compared to the “non-CIN” group) was observed at the 24th hour, but only for creatinine. The authors concluded that patients with diabetes mellitus and preserved renal function are more likely to suffer from subclinical renal impairment, considering them much more susceptible to contrast damage, leading to the early elevation of biomarkers.…”

“…The authors concluded that patients with diabetes mellitus and preserved renal function are more likely to suffer from subclinical renal impairment, considering them much more susceptible to contrast damage, leading to the early elevation of biomarkers. They assumed that the dynamic changes of indicators may be different in diabetic patients and in individuals without DM [ 45 ].…”

“…In relation to the entire studied sample, this result was found in 33.3% of patients, which may exceed some of the cited sources [ 52 ] but covers the wide range reported by others [ 62 ]. As already noted, the selection of a cohort of patients with diabetes mellitus may have altered the sample profile, delivering a higher risk of subclinical renal impairment [ 45 ]. Monitoring of NGAL in such cases may help to detect AKI before the change in serum creatinine.…”