Contrast-induced Nephropathy Following Percutaneous Coronary Intervention at a Tertiary Cardiac Center in Nepal

Abstract

BackgroundContrast-induced nephropathy (CIN) is one of the leading causes of morbidity and mortality including increased financial burden in high risk patients undergoing percutaneous coronary intervention (PCI).MethodsThis is an observational prospective study. We aimed to study the incidence of CIN in Nepalese populations and compare the outcome to international reprinted values with coronary artery disease (CAD) undergoing PCI. All consecutive patients with CAD undergoing PCI between February 2010 and July 2010 were enrolled in the study.ResultsOne hundred fifty-two patients were enrolled in the study during six months period. Twenty (13.20%) patients developed CIN following PCI. Out of them 70% were diabetics and 30% were non-diabetics. Mean age of patients was 58.5 ± 23 years; male:female ratio was 2.7:1. Mean contrast volume injected was 160.3 ± 78.3 mL. Diabetic patients 21.8% (14/64) had significant CIN compared to non-diabetic patients 6.8% (6/88) following PCI (<0.01).ConclusionsCIN is a common complication following PCI especially in diabetics. Despite the use of iodinated material we had similar incidence of CIN comparing the incidence of CIN among various radiocontrast compounds used to visualize vessels. None of the patients received hemodialysis as compared to available studies and there was no observed mortality.

Predictive Capacity of ACEF Score to Detect All-Cause Mortality and Post Contrast Acute Kidney Injury Among PCI Patients

“…The study was done in a short period using purposive sampling which may have led to sampling bias causing an error if it happened. Our study demonstrated similar risk factors for PC-AKI as in various previous studies like higher age 10,13,[18][19][20] heart failure/higher Killip Class 10,13,[18][19][20] Diabetes, 10,[18][19][20][22][23][24] low EF, 10,18 and higher contrast volume. 13,18,21,22 NS hydration was associated with reduction of risk.…”

“…In a study done in Nepal by Sharma et al 23 had incidence of 8.2% however study population had only one-third patients of PCI. In another study done by Mandal et al 24 in this same center in 2010 showed CIN incidence of 13.6%. The difference in rates may be due to alteration in various demographic factors.…”

Oxidative stress and inflammation in the development of cardiovascular disease and contrast induced nephropathy

“…Notably, angioplasty is the most common percutaneous coronary intervention (PCI) method for CVD treatment [37,38] , and diagnostic angiography and PCI routinely utilize iodinated CM for vascular visualization [39,40] . Although angiograms and PCI can effectively diagnose and treat CVD patients, this can potentially lead to acute kidney diseases such as CIN induced by CM [41][42][43][44][45][46] . CM can be retained by the kidney where they have the potential to cause toxicity, resulting in acute renal injury [47] .…”

“…CIN is a reversible form of acute renal injury that becomes evident after 48-72 h of intravascular administration of iodinated CM, manifesting in an increase of at least 25% in the serum creatinine level from baseline [50][51][52] . Although CIN can be transient, and in most of the cases serum creatinine level normalizes in 5-10 days, it can be irreversible and is associated with increased mortality and morbidity [25,45,50,53,54] . CIN is known to increase hospitalization, cardiovascular events, hepatic failure, dialysis and cardiac mortality, thus being directly associated with detrimental cardiac outcomes [50,[55][56][57] .…”

“…Although the precise pathophysiology of CIN is incompletely understood, crucial mechanisms have been associated with CIN, such as vasoconstriction in the renal vasculature, oxidative stress, renal medullary hypoxia, direct renal tubular cytotoxicity, and viscosity [45,53,61] [ Figure 1]. It has been proposed that the interplay of cytotoxicity and viscosity caused by CM, may be key in CIN pathophysiology.…”