Abstract
BackgroundsDiabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to assess whether preoperative HbA1c levels in diabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN.MethodsWe reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020 and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48 h and 72 h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Univariable and multivariable logistic regression analysis was used to exclude the influence of confounding factors, and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN.ResultsPatients with elevated HbA1c had higher BMI, FBG, and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 48 h and 72 h Scr. The incidence of CIN in the 5 groups of patients were: 9.8, 11.9, 15.2, 25.3, 48.1%. (p < 0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. Trend test showed the change of OR (1.000,1.248,1.553,2.625,5.829).ConclusionsStudies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1c is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase. Therefore, we should attach great importance to patients with elevated HbA1c at admission and take more active measures to prevent CIN.
Highlights
Contrast-induced nephropathy (CIN) is reversible acute renal failure observed after administration of iodinated contrast media (CM) during angiographic or other medical procedures
Studies have shown that in diabetic patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI), elevated Glycosylated Hemoglobin (HbA1c) is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase
Current studies have shown that among patients without diabetes undergoing CAG/ PCI elevated HbA1c is independently associated with the risk of CIN [13]
Summary
Contrast-induced nephropathy (CIN) is reversible acute renal failure observed after administration of iodinated contrast media (CM) during angiographic or other medical procedures. Diabetic nephropathy has been identified as a decisive and independent risk factor for CIN [9] Both diabetes and the administration of iodinated radiocontrast agents are associated with marked alterations of renal physiology, including changes in eGFR and renal hemodynamics, enhanced tubular transport activity and oxygen expenditure, and intensification of medullary hypoxia, and ROS generation [10]. Current studies have shown that among patients without diabetes undergoing CAG/ PCI elevated HbA1c is independently associated with the risk of CIN [13]. Compared with previous clinical trials, our study aims to focus on whether the level of HbA1c in diabetic patients undergoing CAG/PCI is related to the risk of CIN
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