Abstract
Background: The risk of contrast-induced acute kidney injury (CI-AKI) following coronary intervention is particularly high among patients with chronic kidney disease (CKD). Among these patients, baseline neutrophil gelatinase-associated lipocalin (NGAL), a marker of tubular damage, reflects the severity of renal impairment. We evaluated whether the baseline serum NGAL level may be a marker for the development of CI-AKI following percutaneous coronary intervention (PCI). Methods: Eighty-eight CKD patients treated with PCI were included. Serum NGAL levels were drawn upon hospital admission. Receiver operator characteristic (ROC) methods were used to identify the optimal sensitivity and specificity for the observed NGAL level compared with the estimated glomerular filtration rate (eGFR) calculated for patients with CI-AKI. Results: Overall CI-AKI incidence was 43%. Baseline serum NGAL levels were significantly higher in patients with CI-AKI than in patients without CI-AKI (150 vs. 103 ng/mL, p < 0.001). According to the ROC curve, baseline NGAL levels performed better than eGFR to predict CI-AKI (AUC 0.753 vs. 0.604), with the optimal cutoff value for baseline NGAL to predict CI-AKI being 127 ng/mL (sensitivity of 68% and specificity of 68%, p < 0.001). In a multivariate logistic regression model, the NGAL level >127 ng/mL ng/mL was independently associated with CI-AKI (HR 9.84, 95% CI: 1.96–40.3; p = 0.01). Conclusion: Baseline serum NGAL levels in CKD patients may identify a high-risk population for CI-AKI following PCI. Further studies on larger populations are required to validate the potential utility of NGAL measurements in monitoring specific CKD-associated conditions.
Highlights
Contrast-induced acute kidney injury (CI-AKI) is a common complication among patients undergoing percutaneous coronary intervention (PCI)
The study included 88 chronic kidney disease (CKD) patients treated with PCI, 38 (43%) of whom developed contrast-induced acute kidney injury (CI-AKI) throughout hospitalization
No difference was demonstrated between the groups regarding baseline estimated glomerular filtration rate (eGFR) or the amount of contrast media used during PCI
Summary
Contrast-induced acute kidney injury (CI-AKI) is a common complication among patients undergoing percutaneous coronary intervention (PCI). Elevated NGAL levels can be detected within a few hours following tubular insult and were found to predict earlier renal injury better than serum creatinine (sCr) [4,5] These findings were demonstrated in various patient populations, including post-cardiac surgery, contrast administration, and septic shock [6,7,8,9]. The risk of contrast-induced acute kidney injury (CI-AKI) following coronary intervention is high among patients with chronic kidney disease (CKD). Among these patients, baseline neutrophil gelatinase-associated lipocalin (NGAL), a marker of tubular damage, reflects the severity of renal impairment. Further studies on larger populations are required to validate the potential utility of NGAL measurements in monitoring specific CKD-associated conditions
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