Contrast-induced acute kidney injury following coronary angiography in patients with end-stage liver disease

Abstract

Background: Contrast-induced acute kidney injury (CIAKI) following coronary angiography is frequently observed in the general population. End-stage liver disease (ESLD) patients are at a particularly increased risk for development of CIAKI following coronary angiography due to preexisting renal hypoperfusion.Methods: We performed a retrospective study of 544 consecutive cardiac catheterizations in ESLD patients from December 2003 to May 2013 to calculate the incidence of CIAKI post-coronary angiography and to identify risk factors for CIAKI. CIAKI was defined as a serum creatinine increase of either ≥ 25% or ≥ 0.5 mg/dL from baseline within 72 hours. Multivariable and Cox regression analysis was performed for development of CIAKI and all-cause mortality, respectively.Results: Overall, 179 cases of coronary angiography were included in the final analysis. CIAKI occurred in 23% of patients. All-cause mortality was 52% in the CIAKI group and 37% in the non-CIAKI group, with a mean follow-up of 2.2 ± 3.8 years. Multivariable analysis identified intensive care unit admission (OR 2.72, CI 1.05–7.01, p < 0.05) and baseline estimated glomerular filtration rate (OR 1.02, CI 1.002–1.035, p < 0.05) as independent predictors of CIAKI. Cox regression analysis identified pre-angiography beta-blocker use (HR 2.13, CI 1.04–4.38, p < 0.05), international normalized ratio (HR 1.37, CI 1.05–1.78, p < 0.05) and Mehran risk score (HR 1.13, CI 1.02–1.25, p < 0.05) as independent predictors of all-cause mortality.Conclusions: CIAKI in ESLD patients undergoing coronary angiography occurs at a moderately elevated rate when compared to the general population.

Impact of oxygen therapy to ameliorate contrast-induced nephropathy in patients with acute coronary syndrome undergoing emergency angiography; a double-blinded clinical trial

“…Indeed, our study approved the effect of gender on the development of CIN (17). This study was one of the few studies conducted on the effect of oxygen therapy on nephropathy in patients undergoing angiography with more studied variables such as age, gender, EF, GFR, chronic renal disease, heart disease, diabetes, hypertension and ACE inhibitors and also diuretics, which was one of the strengths of this research.…”

“…These findings were inconsistent with previous studies. In the study of Minoo et al, the prevalence of CIN in individuals undergoing oxygen therapy were significantly lower than control group (18.6% versus 41.5%) (17), while in the study of Sekiguchi et al, the results were the same with the study by Minoo et al (0.6% versus 5.1%) (16). The type of procedure in our study was emergency, while the two previous studies have been performed electively and the hemodynamic status of the patients was stable, in such a way that the risk of CIN is less in elective patients from those of in emergency patients.…”

“…Since CIN begins immediately after the exposure to the contrast agent, it is assumed that adequate oxygenation before exposure to the contrast accompanied with hydration by isotonic saline can prevent CIN more effectively. Recent studies have also suggested that the addition of supplemental oxygen to hydration leads to a significant reduction in CIN development from that of hydration alone (16,17).…”

Frequency of Acute Kidney Injury Among Patients Undergoing Coronary Angiography

“…This study was conducted in the in the Department of Cardiology, Hayatabad Medical Complex, Peshawar from 22 nd Jan 2018 to 22 nd Jul 2018. A Sample of 116 was included through non probability consecutive sampling, with sample size being calculated using 18% 12 proportion of AKI after coronary angiography, 95% confidence interval and 7% margin of error. Our sample included patients 18 years of age or above with baseline creatinine below 1.2mg/dl who were undergoing coronary angiography for any reason.…”

“…In Neyra et al, a sample of 1160 patients were studied for the development of CIAKI and it was found that it occurred in 19% of CRF cases and in 18% of non-CRF cases 12 . The other reported incidence of CIAKI after coronary intervention is 23% 13 and 29.5% 14 .…”