Abstract
Preexisting renal impairment and the amount of contrast media are the most important risk factors for contrast-induced acute kidney injury (CI-AKI). We aimed to investigate whether the product of contrast medium volume and urinary albumin/creatinine ratio (CMV × UACR) would be a better predictor of CI-AKI in patients undergoing nonemergency coronary interventions. This was a prospective single-center observational study, and 912 consecutive patients who were exposed to contrast media during coronary interventions were investigated prospectively. CI-AKI is defined as a 44.2 μmol/L rise in serum creatinine or a 25% increase, assessed within 48 h after administration of contrast media in the absence of other causes. Fifty patients (5.48%) developed CI-AKI. The urinary albumin/creatinine ratio (UACR) (OR = 1.002, 95% CI = 1.000–1.003, p = .012) and contrast medium volume (CMV) (OR = 1.008, 95% CI = 1.001–1.014, p = .017) were independent risk factors for the development of CI-AKI. The area under the ROC curve of CMV, UACR and CMV × UACR were 0.662 (95% CI = 0.584–0.741, p < .001), 0.761 (95% CI = 0.674–0.847, p < .001) and 0.808 (95% CI = 0.747–0.896, p < .001), respectively. The cutoff value of CMV × UACR to predict CI-AKI was 1186.2, with 80.0% sensitivity and 62.2% specificity. The product of CMV and UACR (CMV × UACR) might be a predictor of CI-AKI in patients undergoing nonemergency coronary interventions, which was superior to CMV or UACR alone.
Highlights
Contrast-induced acute kidney injury (CI-AKI) is defined as an abrupt deterioration in renal function associated with the administration of iodinated contrast media, and it is the third most common cause of hospitalacquired acute kidney injury (AKI) after impaired renal perfusion and use of nephrotoxic medications [1,2,3]
From March 2010 to February 2011, all consecutive patients (n 1⁄4 949) who underwent nonemergency coronary interventions (CAG and percutaneous coronary intervention (PCI)) admitted to our hospital were considered for enrollment in the study
Our study found that contrast medium volume (CMV) was one of the independent risk factors for the development of confidence intervals (CIs)-AKI
Summary
Contrast-induced acute kidney injury (CI-AKI) is defined as an abrupt deterioration in renal function associated with the administration of iodinated contrast media, and it is the third most common cause of hospitalacquired acute kidney injury (AKI) after impaired renal perfusion and use of nephrotoxic medications [1,2,3]. Among all procedures utilizing contrast media for diagnostic or therapeutic purposes, coronary angiography (CAG) and percutaneous coronary intervention (PCI) are associated with the highest rates of CI-AKI [3,4]. It is still not completely understood, medullary hypoxia and direct tubular toxicity of the contrast media are accepted as the main pathophysiological mechanisms of CI-AKI [5,6]. Albuminuria is a direct consequence of renal glomerular/tubular injury and increases with glomerular dysfunction [16] It is a known marker for progression of chronic renal disease.
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