open access

Online first
Original article
Published online: 2022-05-06
Get Citation

Risk factors of contrast induced nephropathy in patients with acute coronary syndromes

Tomasz Rakowski1, Artur Dziewierz1, Michał Węgiel1, Zbigniew Siudak2, Wojciech Zasada3, Jacek Jąkała4, Dominika Dykla5, Jerzy Matysek4, Andrzej Surdacki1, Stanisław Bartuś1, Dariusz Dudek1, Roman Wojdyła3
DOI: 10.33963/KP.a2022.0123
·
Pubmed: 35521717
Affiliations
  1. Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  2. Collegium Medicum, Jan Kochanowski University, Kielce, Poland
  3. 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
  4. Krakow Center of Invasive Cardiology, Electrotherapy and Angiology, Kraków, Poland
  5. Center of Invasive Cardiology, Electrotherapy and Angiology in Nowy Sącz, Nowy Sącz, Poland

open access

Online first
Original article
Published online: 2022-05-06

Abstract

BACKGROUND: Patients with acute coronary syndromes (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization and higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed.

AIMS: Our aim was to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment.

METHODS: A total of 2,638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 µmol/l) increase in absolute value.

RESULTS: Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referring to other treatment strategies (P <0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was the independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P <0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN.

CONCLUSIONS: Despite intravenous fluid administration during the hospital stay, CIN persisted until hospital discharge in more than 10% of patients with ACS. Anemia at baseline, STEMI presentation and immediate PCI strategy were independent predictors of CIN. Thus, preventive actions should be specially aimed at those groups of patients.

 

Abstract

BACKGROUND: Patients with acute coronary syndromes (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization and higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed.

AIMS: Our aim was to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment.

METHODS: A total of 2,638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 µmol/l) increase in absolute value.

RESULTS: Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referring to other treatment strategies (P <0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was the independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P <0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN.

CONCLUSIONS: Despite intravenous fluid administration during the hospital stay, CIN persisted until hospital discharge in more than 10% of patients with ACS. Anemia at baseline, STEMI presentation and immediate PCI strategy were independent predictors of CIN. Thus, preventive actions should be specially aimed at those groups of patients.

 

Get Citation

Keywords

contrast-induced nephropathy, acute coronary syndrome, percutaneous coronary intervention, anemia

Supp./Additional Files (1)
Supplementary material
Download
103KB
About this article
Title

Risk factors of contrast induced nephropathy in patients with acute coronary syndromes

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-05-06

Page views

59

Article views/downloads

26

DOI

10.33963/KP.a2022.0123

Pubmed

35521717

Keywords

contrast-induced nephropathy
acute coronary syndrome
percutaneous coronary intervention
anemia

Authors

Tomasz Rakowski
Artur Dziewierz
Michał Węgiel
Zbigniew Siudak
Wojciech Zasada
Jacek Jąkała
Dominika Dykla
Jerzy Matysek
Andrzej Surdacki
Stanisław Bartuś
Dariusz Dudek
Roman Wojdyła

References (24)
  1. Bagshaw SM, Culleton BF, Bagshaw SM, et al. Theophylline for prevention of contrast-induced nephropathy: a systematic review and meta-analysis. Arch Intern Med. 2005; 165(10): 1087–1093.
  2. Marenzi G, Lauri G, Assanelli E, et al. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 2004; 44(9): 1780–1785.
  3. Silvain J, Nguyen LS, Spagnoli V, et al. Contrast-induced acute kidney injury and mortality in ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Heart. 2018; 104(9): 767–772.
  4. Lang J, Patyna S, Büttner S, et al. Incidence, risk factors and prognostic impact of acute kidney injury after coronary angiography and intervention in kidney transplant recipients: a single-center retrospective analysis. Postepy Kardiol Interwencyjnej. 2020; 16(1): 58–64.
  5. Chong E, Poh KK, Liang S, et al. Comparison of risks and clinical predictors of contrast-induced nephropathy in patients undergoing emergency versus nonemergency percutaneous coronary interventions. J Interv Cardiol. 2010; 23(5): 451–459.
  6. Mehran R. Contrast-induced nephropathy remains a serious complication of PCI. J Interv Cardiol. 2007; 20(3): 236–240.
  7. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008; 51(15): 1419–1428.
  8. Legnazzi M, Agnello F, Capodanno D. Prevention of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention. Kardiol Pol. 2020; 78(10): 967–973.
  9. ACT Investigators. Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011; 124(11): 1250–1259.
  10. Boscheri A, Weinbrenner C, Botzek B, et al. Failure of ascorbic acid to prevent contrast-media induced nephropathy in patients with renal dysfunction. Clin Nephrol. 2007; 68(5): 279–286.
  11. Quintavalle C, Fiore D, De Micco F, et al. Impact of a high loading dose of atorvastatin on contrast-induced acute kidney injury. Circulation. 2012; 126(25): 3008–3016.
  12. Zhang T, Shen LH, Hu LH, et al. Statins for the prevention of contrast-induced nephropathy: a systematic review and meta-analysis. Am J Nephrol. 2011; 33(4): 344–351.
  13. Patti G, Ricottini E, Nusca A, et al. Short-term, high-dose Atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the ARMYDA-CIN [atorvastatin for reduction of myocardial damage during angioplasty--contrast-induced nephropathy] trial. Am J Cardiol. 2011; 108(1): 1–7.
  14. Jurado-Román A, Hernández-Hernández F, García-Tejada J, et al. Role of hydration in contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention. Am J Cardiol. 2015; 115(9): 1174–1178.
  15. Brar SS, Shen AYJ, Jorgensen MB, et al. Sodium bicarbonate vs sodium chloride for the prevention of contrast medium-induced nephropathy in patients undergoing coronary angiography: a randomized trial. JAMA. 2008; 300(9): 1038–1046.
  16. Weisbord SD, Palevsky PM. Prevention of contrast-induced nephropathy with volume expansion. Clin J Am Soc Nephrol. 2008; 3(1): 273–280.
  17. Sacha J, Gierlotka M, Feusette P, et al. Ultra-low contrast coronary angiography and zero-contrast percutaneous coronary intervention for prevention of contrast-induced nephropathy: step-by-step approach and review. Postepy Kardiol Interwencyjnej. 2019; 15(2): 127–136.
  18. Dangas G, Iakovou I, Nikolsky E, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol. 2005; 95(1): 13–19.
  19. Nikolsky E, Mehran R, Lasic Z, et al. Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions. Kidney Int. 2005; 67(2): 706–713.
  20. Sreenivasan J, Zhuo M, Khan MS, et al. Anemia (Hemoglobin ≤ 13 g/dL) as a Risk Factor for Contrast-Induced Acute Kidney Injury Following Coronary Angiography. Am J Cardiol. 2018; 122(6): 961–965.
  21. Li Wh, Li Dy, Han F, et al. Impact of anemia on contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary interventions. Int Urol Nephrol. 2013; 45(4): 1065–1070.
  22. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004; 44(7): 1393–1399.
  23. Sendeski MM, Persson AB, Liu ZZ, et al. Pathophysiology of renal tissue damage by iodinated contrast media. Clin Exp Pharmacol Physiol. 2011; 38(5): 292–299.
  24. Uygur B, Celik O, Demir AR, et al. A simplified acute kidney injury predictor following transcatheter aortic valve implantation: ACEF score. Kardiol Pol. 2021; 79(6): 662–668.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Sp. z o.o. VM Group Sp.k., ul. Świętokrzyska 73 , 80–180 Gdańsk, Poland

phone:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl