Coronary artery calcification scores improve contrast-induced nephropathy risk assessment in chronic kidney disease patients.

Abstract

Coronary artery calcification (CAC) is an independent predictor of cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. The aim of the present study was to evaluate the predictive value of CAC scores for the incidence of contrast-induced nephropathy (CIN) after cardiac catheterization in non-dialyzed CKD patients. The present study evaluated a total of 140 CKD patients who underwent cardiac catheterization. Patients were stratified into two groups based on the optimal cut-off value of the CAC score, which was graded by a non-triggered, routine diagnostic chest computed tomography scan: CAC score≥8 (high CAC group); and CAC score<8 (low CAC group). CIN was defined as an increase of>10% in the baseline serum cystatin C level at 24h after contrast administration. The mean estimated glomerular filtration rate levels were 41.1mL/min/1.73m2, and the mean contrast dose administered was 37.5mL. Patients with high CAC scores exhibited a higher incidence of CIN than patients with low CAC scores (25.5 vs. 3.2%, p<0.001). After multivariate adjustment for confounders, the CAC score predicted CIN (odds ratio 1.68, 95% confidence interval 1.28-2.21, p<0.001). Moreover, the C-index for CIN prediction significantly increased when the CAC scores were added to the Mehran risk score (0.855 vs. 0.760, p=0.023). CAC scores, as evaluated using semi-quantitative methods, are a simple and powerful predictor of CIN. Incorporating the CAC score in the Mehran risk score significantly improved the predictive ability to predict CIN incidence.