Albuminuria Pre-Emptively Identifies Cardiac Patients at Risk of Contrast-Induced Nephropathy.

Laura Vicente-Vicente,Carlos Martínez-Salgado,M Teresa Hernández-Sánchez,Marta Prieto,Ignacio Cruz-González,Ana I Morales,Alfredo G Casanova,Francisco J López-Hernández

doi:10.3390/jcm10214942

Abstract

Contrast-induced nephropathy (CIN) is a complication associated with the administration of contrast media (CM). The CIN diagnosis is based on creatinine, a biomarker late and insensitive. The objective proposed was to evaluate the ability of novel biomarkers to detect patients susceptible to suffering CIN before CM administration. The study was carried out with patients undergoing cardiac catheterization involving CM. Patients were divided into two groups: (1) CIN, patients who developed this pathology; (2) control, patients who did not suffer CIN. Prior to the administration of CM, urine samples were collected to measure proteinuria, N-acetyl-β-d-glucosaminidase, neutrophil gelatinase-associated lipocalin and kidney injury molecule-1, albumin, transferrin, t-gelsolin and GM2 ganglioside activator protein (GM2AP). The risk factors advanced age, low body mass index and low estimated glomerular filtration rate; and the urinary biomarkers albumin, transferrin and GM2AP showed significant predictive capacity. Of all of them, albuminuria demonstrated the highest diagnostic power. When a cutoff point was established for albuminuria at values still considered subclinical (10–30 µg/mg Cru), it was found that there was a high incidence of CIN (40–75%). Therefore, albuminuria could be applied as a new diagnostic tool to prevent and predict CIN with P4 medicine criteria, independently of risk factors and comorbidities.

Highlights

In recent years, progress in the field of interventional cardiology has allowed the safer management of patients at risk in diagnostic and interventional procedures
Information regarding the type and volume of contrast media (CM) used was obtained from each patient since these aspects may influence the alteration of renal functionality
No significant differences were observed between groups, either in the type of CM or in the volume used

Summary

Introduction

Progress in the field of interventional cardiology has allowed the safer management of patients at risk in diagnostic and interventional procedures. The definition establishes 3 days as an observation period to assess creatinine progress, it has been observed that this biomarker can reach its maximum value up to the fifth day and return to baseline values 7–10 days after CM [3]. The incidence of CIN varies between 3% in patients with normal kidney function and 40% in patients with chronic kidney disease [4]. It is the third leading cause of hospital-acquired acute kidney damage [5], of which half occurs in patients undergoing cardiac catheterization or percutaneous coronary interventions, such as angioplasties [6]

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Conclusion