SAT-030 CONTRAST INDUCED NEPHROPATHY IN HIGH RISK PATIENTS – MYTH OR REALITY

Abstract

Contrast induced nephropathy (CIN) is a potential complication of administration of contrast media. CIN is defined as an elevation of serum creatinine (Scr) of more than 25% or ≥0.5 mg/dl (44 μmol/l) from baseline within 48-72 hours in the absence of alternate causes of acute kidney injury (AKI). Incidence of contrast induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography with normal baseline renal function was reported to be < 2%7. However, the incidence of CI-AKI was found to be as high as 50% in chronic kidney disease (CKD) patients undergoing Coronary Angiography. This high incidence reported by studies is mainly due to differences in definition, background renal failure, types and dose of contrast medium used and frequency of other co-existing potential cause of AKI. Recent studies have been published showing that risk of CIN is an ‘overestimated entity” in the literature. The objective of this study is to determine the frequency of CIN in CKD patients with creatinine clearance (CrCl) less than 60ml/min undergoing contrast exposure. We conducted prospective, controlled single center trial in 44 patients with CrCl than 60ml/min who were risk stratified according to Mehran scoring system and underwent coronary angiography or contrast enhanced CT scan and specific protocol for prevention of CIN i.e. IV Hydration with 0.9% Normal Saline was given before procedure and were followed up to 72 hours post procedure. Thirty-three patients out of Forty-Four patients (75%) got adequate hydration as per protocol however eleven patients underwent procedure without hydration as preexisting condition did not allow so. Out of forty-four patients, risk stratification according to Mehran protocol revealed that fifteen out of forty-four patients (34%) were in very high-risk group, sixteen (36%) were in High risk group and thirteen (29%) were in intermediate risk group. Our experience revealed that five Patients out of total Forty-Four patients (11.3%) suffered from Contrast induced Nephropathy and none of them needed hemodialysis. Our study has raised a serious question regarding the incidence of Contrast induced Nephropathy in High risk patients as reported previously. However, more studies are needed on this issue. Till that time, we might consider CIN “a myth rather than a reality”.