Risk factors for contrast induced nephropathy: A study among Italian patients

Abstract

Atherosclerosis Percutaneous coronary intervention Coronary angiography a b s t r a c tThis study aimed to make a profile of patients at highest risk of developing contrast induced nephropathy (CIN) in order to take appropriate prevention measures. 591 patients undergoing coronary procedures were divided into two groups: patients with (CIN-group) and without (no-CIN) an increase in creatinine level equal or more than 25% from baseline values within 24e48 h after the coronary procedure. All patients underwent an accurate anamnesis, objective exam, hematochemical measurements, and diagnostic exams. The results of this study while confirming that, average age ( p ¼ 0.01), diabetes mellitus IntroductionContrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute renal failure, accounting for 10% of all cases of hospital-acquired renal failure. 1 It is commonly defined as an acute deterioration of the renal function characterized by a significant increase in serum creatinine levels, usually more than 0.5 mg/dl (44 mmol/L) or 25% of baseline levels, within 24e48 h after exposure to a contrast agent compared to baseline serum creatinine values, when alternative explanations for renal impairment have been excluded. 2 The CIN is associated with increased mortality and morbidity and costs, 3e5 in fact, although usually transient, its resolution needs 1e3 weeks on average, the impairment of renal function may be permanent in some cases with the risk of progression towards chronic renal failure and the necessity of a temporary or permanent dialysis. 6 Prevention is the key to reduce the incidence of CIN and it begins with identification of the high risk patient coupled with appropriate peri-procedural management. Many studies have been conducted to identify the main risk factors for CIN, in fact many score systems have been proposed 7e12 and increasing number of guidelines have been suggested in literature 13,14 to help lessen the complication of CIN. Available online at www.sciencedirect.com journal homepage: w ww.el sevier.com/locate /ihj i n d i a n h e a r t j o u r n a l 6 4 ( 2 0 1 2 ) 4 8 4 e4 9 1

The effect of radiological contrast media on renal function and inflammatory markers in people with diabetes – a clinical study and review

“…[15][16][17] Elevated CRP prior to exposure to CM is a significant and independent predictor of CIN; inflammation is a pro-thrombotic state and elevated levels of inflammatory markers may contribute to increased plasma viscosity and subsequent tubular damage. 10,11 Consequences of administration of contrast medium Our study supports previous findings that people with co-existing diabetes and renal dysfunction are at increased risk of CIN 7,18,19 : all five of our patients who developed CIN had pre-existing CKD. The risk of CIN has been shown to be related to the severity of pre-existing CKD, 20,21 but the exact relationship and the point at which damage is most likely to occur has yet to be determined.…”

“…22,23 Inflammatory markers Elevated levels of inflammatory markers, in particular CRP, prior to administration of CM may play a role in CIN following coronary angiography. 10,11 A recent study involving 423 patients found that 13.5% of patients with CRP >5 mg/dL developed CIN, compared with 6.25% of patients with a lower level of CRP. 24 We found no significant difference in renal function when patients were divided into groups depending on their CRP level at baseline.…”

“…6 Diabetes is one of a number of independent risk factors for developing CIN (along with hypotension, use of an intra-aortic balloon pump, heart failure, advanced age, high serum creatinine, anaemia, chronic kidney disease (CKD) and administration of a large volume of CM), 7 and evidence is emerging for a role of the inflammatory marker C-reactive protein (CRP). [8][9][10][11] CRP has been implicated in preventing vasodilation by increasing the activity of inhibitors of nitric oxide synthase and is widely recognised as a non-specific marker for systemic inflammation. 12 Insulin resistance and diabetes are recognised as a generalised inflammatory states with raised CRP concentrations.…”

Risk factors and outcomes of contrast-induced nephropathy in hospitalised South Africans

“…[1][2][3][4] The rates of CIN vary, depending on the study definitions employed and underlying risk factors, and range from 0.6% to 30% or higher among risk groups. [5][6][7][8] CIN is also associated with increased duration of hospitalisation and early and late mortality.…”

Incidence and Risk Factors of Contrast Induced Nephropathy in Patients Following Coronary Angiography

“…No statistical significant sex difference was observed. In study ofEvola et al (2012) observed that average age was 65.32 ± 12.02 years in no-CIN group and 68.94±11.31 years in CIN group. Male was found 337 (69.3%) patients in no-CIN group and 69 (65.7%) in CIN group.…”