Incidence of and Risk Factors for Contrast-Induced Nephropathy After Cardiac Catheterization in Japanese Patients

Abstract

Circ J 2009; 73: 1518 -1522 odinated contrast medium used in diagnostic and therapeutic cardiac catheterization can cause renal damage, which ranges from a transient elevation of the serum creatinine (SCr) concentration to permanent renal failure necessitating dialysis. 1,2 Recent studies have shown that contrast-induced nephropathy (CIN) is the third leading cause of all hospital-acquired renal insufficiency, accounting for 10%, 3 and is associated with increased long-term mortality. 4 CIN is defined as an increase in SCr ≥0.5 mg/dl or ≥25% of the baseline level reaching a peak between 2 and 5 days after administration of the contrast medium. [5][6][7] The incidence of CIN in previous reports varies among studies because of differences in the definition of CIN, background risk, type and dose of contrast medium, and the frequency of other potential causes of CIN. 6 The most important risk factor for CIN is preexisting renal insufficiency. 8,9 Older age, female gender, anemia, high-dose usage of contrast medium, heart failure, diabetes mellitus and peripheral vascular disease (PVD) are also reported as risk factors that increase the likelihood of CIN. [9][10][11][12] It is still uncertain to what extent these factors independently worsen renal function.The incidence of and risk factors for CIN in Japanese patients are unknown at present, so we retrospectively analyzed a Japanese cohort. Methods Study Design and PatientsWe retrospectively examined all Japanese patients who underwent cardiac catheterization in the Department of Cardiovascular Medicine at Kyoto University Hospital from January 2003 to December 2004. Patients on hemodialysis before catheterization and patients without laboratory data were excluded. Patients were administered iomeprol 350 (Iomeron; Bracco Eisai Co, Ltd, Tokyo, Japan; 350 mg iodine/ml) or iopamidol 370 (Iopamiron; Bayer, Osaka, Japan; 370 mg iodine/ml) during cardiac catheterization, and were admitted for intravenous hydration before and after the procedure at the discretion of their physicians.This study was approved by the Ethics Committee of Kyoto University Graduate School of Medicine and the informed consent was waived because it was conducted in historical cohort fashion without any intervention and individual identification information was not used. DefinitionsIn the present study, CIN was defined as an elevation in SCr concentration ≥0.5 mg/dl or 25% within 5 days after cardiac catheterization. 4,[13][14][15][16] Older age (elderly), underweight, anemia, and preexisting renal insufficiency were defined as ≥70 years old, body mass index (BMI) <18.5, 17 hemoglobin (Hb) concentration <13 g/dl for men and <12 g/dl Incidence of and Risk Factors for Contrast-Induced Nephropathy After Cardiac Catheterization in Japanese PatientsMitsuru Abe, MD; Takeshi Kimura, MD*; Takeshi Morimoto, MD**; Yutaka Furukawa, MD † ; Toru Kita, MD † Background: Contrast-induced nephropathy (CIN) is the third leading cause of all hospital-acquired renal insufficiency, accounting for 10%, and is associated...

Remote Ischemic Pre-Conditioning Alleviates ContrastInduced Acute Kidney Injury in Patients With Moderate Chronic Kidney Disease

“…volume expansion proposed by Stacul et al 34 Third, the mean dose of contrast medium was lower in the present study than in previous studies (92 vs. 186-190 ml). 1, 35 For reasons already stated, the incidence of creatinine-based CIN in the present study was lower. Nevertheless, urinary L-FABP level at 24 h was obviously increased after use of contrast in the control group.…”

Clinical Predictors of Contrast-Induced Acute Kidney Injury in Patients Undergoing Emergency Versus Elective Percutaneous Coronary Intervention

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Minimizing Contrast Dose According to Estimated Glomerular Filtration Rate

“…In the previous study based on SCr, female sex and underweight (BMI <18.5) were independently associated with CI-AKI. 3 Because SCr is a marker for both GFR and body muscle mass, sex and body weight might be associated with body muscle mass regardless of GFR. Meanwhile, sex and BMI were not significant predictors for CI-AKI in the present study based on eGFR, 8 suggesting the superiority of CV/eGFR.…”