Relation between pre-procedural increase in urinary albumin excretion and changes in estimated glomerular filtration rate after coronary angiography in diabetic patients

Abstract

Abstract Background Contrast-induced nephropathy (CIN), is an acute impairment in renal function, and typically occurs within 3 days following the exposure to a contrast medium (CM). It is associated with increased hospital stay and increased morbidity and mortality, Adult patients with diabetes have a higher risk than the general population for developing contrast induced nephropathy. Methods The current study includes 40 patients with diabetes mellitus, scheduled for coronary angiography with estimated GFR >60 ml/min .the patients were divided according to their pre-procedural urinary albumin creatinine ratio (ACR) results into 3 groups: Group 1 included patients with pre-procedure urinary albumin creatinine ratio < 30mg/g, Group 2 included patients with pre- procedure albumin creatinine ratio 30- 300 mg/g and Group 3 included patients with pre-procedure albumin creatinine ratio >300 mg/g . Estimated GFR (glomerular filtration rate) calculated using MDRD and serum creatinine were measured at day 2 and 3 (Day +2 +3) after coronary angiography. Results There was no statistically significant difference in the age and gender distribution, the use of ACEIs (angiotension converting enzyme inhibitors) or diuretics between the cases who developed and who didn’t develop CIN. The mean ACR in the group with no contrast induced nephropathy was 225.38 ± 209.53 which was statistically significantly lower when compared with the cases with contrast induced nephropathy (420.43± 348.52) (p = 0.033). The mean HbA1c in no contrast induced nephropathy group was 7.11 ± 0.64 and in contrast induced nephropathy group it was 9.09 ± 0.66 which is significantly higher (P > 0.001).With univariate regression analysis, ACR, HbA1c and number of vessels affected were shown to be risk factors for occurrence of CIN after use of contrast, but with multivariate analysis, both ACR and HbA1c were shown to be risk factors for CIN. Conclusion An increase in albumin creatinine ratio in itself can be a risk factor for development of contrast induced nephropathy in diabetic patients.