Definition Of Contrast-induced Nephropathy Research Articles

Efficacy of Trimetazidine in the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Contrast Coronary Intervention: A Systematic Review and Meta-Analysis (PRISMA).

Objective: The present systematic review assessed the efficacy of peri-procedurally administered trimetazidine in the prevention of contrast-induced nephropathy (CIN) in patients undergoing coronary interventions with contrast agents. Methods: We performed a systematic literature review of articles published in PubMed and Google Scholar by 7 December 2023 and included articles from the last 15 years that evaluated the efficacy of trimetazidine in preventing CIN in cardiac patients undergoing coronary intervention. Results: After title/abstract and full-text screening, this systematic review included 9 randomized controlled trials (N = 2158 patients) with two groups: Trimetazidine (60-70 mg/day 24 to 48 h before and up to 72 h after the procedure) with hydration and the control group with only hydration. A total of 234/2158 patients developed CIN (Incidence rate [IR], 10.8%) as per the CIN definition of the Contrast Media Safety Committee of the European Society of Urogenital Radiology. The incidence of CIN in the trimetazidine vs. control group was 6.4% (69/1083) vs. 15.4% (165/1075), and the odds ratio (95% CI) was 0.3753 (0.279-0.504). Conclusions: In conclusion, the trimetazidine group had a lower incidence of CIN. Trimetazidine offers a reno-protective effect and helps in reducing the CIN incidence in patients undergoing cardiac intervention. Peri-procedure administration of trimetazidine significantly decreases the risk of CIN in patients despite comorbidities.

Predictive value of two different definitions of contrast-associated acute kidney injury for long-term major adverse kidney events in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

It remains controversial whether contrast-associated acute kidney injury (CA-AKI) is associated with long-term major adverse kidney events (MAKE) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). By the Acute Kidney Injury Network (AKIN) criteria, CA-AKI was defined as an increase in serum creatinine ≥ 0.3 mg/dL or 50% from baseline within 48 h after PCI; or an increase in serum creatinine ≥ 0.5 mg/dL or 25% within 72 h by the contrast-induced nephropathy (CIN) criteria. The primary endpoint was 1-year MAKE, defined as a composite of all-cause mortality and persistent renal dysfunction. A total of 402 patients were finally included in this study. The primary endpoint occurred in 29 (7.2%) patients. There was a significant association between CA-AKI and 1-year MAKE assessed by both the AKIN (hazard ratios [HR]: 11.58, 95% confidence interval [CI]: 4.29-31.24, p = 0.000) and CIN (HR: 6.45, 95% CI: 2.56-16.25, p = 0.000) definitions. However, the AKIN definition (HR: 4.95, 95% CI: 1.17-21.02, p = 0.030) was more reliable in the prediction of persistent renal dysfunction than CIN definition (HR: 4.08, 95% CI: 0.99-16.87, p = 0.052). Additionally, the area under receiver operating characteristic curve was larger for predicting 1-year MAKE with the AKIN definition than CIN definition (0.742 vs. 0.727). In patients with STEMI undergoing primary PCI, CA-AKI was significantly associated with 1-year MAKE. Moreover, the AKIN definition might be more reliable in the prediction of long-term prognosis.

The predictive value of hemoglobin to creatinine ratio for contrast-induced nephropathy in percutaneous coronary interventions.

Hemoglobin and creatinine levels are important factors for contrast induced nephropathy (CIN) development. Our aim in this study is to investigate the predictive value of hemoglobin to creatinine ratio for CIN development in patients with percutaneous coronary intervention (PCI). A total of 500 patients who underwent PCI in our clinic were evaluated prospectively in terms of CIN. Hemoglobin to creatinine ratio is calculated as baseline hemoglobin/baseline serum creatinine value. glomerular filtration rate (GFR) was calculated with Cockcroft-Gault formula. The definition of CIN includes absolute (≥0.5mg/dL) or relative increase (≥25%) in serum creatinine at 48-72h after exposure to a contrast agent compared to baseline serum creatinine values. CIN was detected in 13.8% (69 patients) of 500 patients. In multivariate lineer regression analysis, hemoglobin to creatinine ratio (beta:-0.227, p=0.03) and ejection fraction (EF) (beta:-0.161, p<0.001), contrast amount used (beta: 0.231, p<0.001) were found to be significant predictors for the development of CIN. In receiver operating characteristics (ROC) analysis; AUC=0.730 (0.66-0.79) for hemoglobin to creatinine ratio, p<0.001, AUC=0.694 (0.62-0.76) for EF, p<0.001 and AUC=0.731 (0.67-0.78) for contrast amount used p<0.001. Hemoglobin to creatinine ratio, EF and contrast amount used were independent predictors for CIN development in patients with PCI (NCT04703049).

Contrast induced nephropathy after percutaneous coronary intervention: Observational Study

The incidence of Contrast-induced nephropathy (CIN) varies because of differences among the published studies in the definition of CIN, the proportion of high-risk patients, the types of contrast media, and the use of preventive measures. The purpose of our study was to determine the incidence of CIN among patients admitted for ST-Elevation Myocardial Infarction (STEMI) in the department of cardiology of Nabeul Hospital Center. Eighty patients were included. All the patients were admitted for a STEMI in the cardiology department of Nabeul Hospital Center from January 2020 to June 2020. The overall pooled CIN incidence was 8% The forest plots showed positive associations between CIN and the presence of hypertension, diabetes mellitus, history of prior myocardial infarction, age, stenosis of left anterior descending artery, Killip class ≥ 2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction < 40%. At a median follow-up of 12 months, major cardiovascular events including cardiovascular death, reinfarction, and stroke were more frequents in patients with CIN (12.5% vs. 2.5%, P -value < 0.001). Contrast-induced nephropathy is common after PCI in patients with STEMI and always leads to a poor prognosis. It is associated with increased rate of cardio-vascular complications at medium and long-term follow-up.

The Relation between Pre-Procedural Increase in Urinary Albumin Excretion and Changes in Estimated Glomerular Filtration Rate after Coronary Angiography in Diabetic Patients

Background: Contrast-induced nephropathy (CIN), is an acute impairment in renal function, and typically occurs within 3 days following the exposure to a iodinated 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. Objective: To assess the significance of preprocedural microalbuminuria on renal function changes post coronary angiography. Patients and methods: The current study included 40 patients all over the age of 18 years, with diabetes mellitus type 1 or type 2, scheduled for coronary angiography with estimated GFR > 60 ml/min. Results: incidence of contrast-induced nephropathy in this study was 40 % (n=16) of patients while 60% (n = 24) did not fit the definition of CIN. There was no statistically significant difference in the age, gender distribution and use of angiotension converting enzyme inhibitors (ACEIs) or diuretics between the cases who developed and who did not develop CIN. The mean albumin creatinine ratio (ACR) in the group with no contrast induced nephropathy was 225.38 ± 209.53 which was statistically significantly lower when compared to 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 was 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 urinary albumin creatinine ratio in itself maybe be a risk factor for development of contrast-induced nephropathy in diabetic patients.

The effect of trimetazidine on preventing contrast-induced nephropathy after cardiac catheterization.

Trimetazidine has been shown to prevent the risk of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing percutaneous coronary intervention (PCI). However, the effect of trimetazidine on CIN in unselected patients is unknown. We aimed to evaluate the effect of trimetazidine on preventing CIN in unselected patients treated with PCI. 2154 consecutive patients were enrolled and divided into the trimetazidine (n = 529) and non-trimetazidine group (n = 1625). Patients in the trimetazidine group received trimetazidine 20mg thrice daily starting at least 24h before the procedure and continuing until discharge. The primary outcome was CIN. CIN was observed in 197 (9.2%) patients. The incidence of CIN was similar between two groups (9.1% vs. 9.2%, P = 0.947). After adjusting for other potential risk factors, trimetazidine did not significantly reduce the risk of CIN (OR = 0.70, 95% CI 0.46-1.08, P = 0.104). The results remained similar when using the alternate definitions of CIN and different subgroup analysis based on diabetes or chronic kidney disease. In additional, no significant difference between two groups was found with respect to in-hospital major adverse clinical events (1.89% vs. 1.66%, P > 0.05). Trimetazidine did not exert significant renal protective effect on preventing CIN and in hosptialmajor adverse clinical events in unselected patients undergoing PCI.

Prevention of contrast-induced nephropathy by adequate hydration combined with isosorbide dinitrate for patients with renal insufficiency and congestive heart failure.

Adequate hydration remains the mainstay of contrast-induced nephropathy prevention, and nitrates could reduce cardiac preload. This study aimed to explore the adequate hydration with nitrates for patients with chronic kidney disease (CKD) and congestive heart failure (CHF) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time avoid the acute heart failure. Three hundred and ninty-four consecutive patients with CKD and CHF undergoing coronary procedures were randomized to either adequate hydration with nitrates (n = 196) or to routine hydration (control group; n = 198). The adequate hydration group received continuous intravenous infusion of isosorbide dinitrate combined with intravenous infusion of isotonic saline at a rate of 1.5 mL/kg/h during perioperative period. The definition of CIN was a 25% or 0.5 mg/dL rise in serum creatinine over baseline. This trial is registered with www.clinicaltrials.gov, number NCT02718521. Baseline characteristics were well-matched between the two groups. CIN occurred less frequently in adequate hydration group than the control group (12.8% vs 21.2%; P = 0.018). The incidence of acute heart failure did not differ between the two groups (8 [4.08%] vs 6[3.03%]; P = 0.599). Cumulative major adverse events (death, myocardial infarction, stoke, hospitalization for acute heart failure) during the 90-day follow-up were lower in the adequate hydration with nitrates group (P = 0.002). Adequate hydration with nitrates can safely and effectively reduce the risk of CIN in patients with CKD and CHF.

Retrospective Analysis of Outcomes in Acute Myeloid Leukemia (AML) Patients Exposed to Intravenous Contrast Prior to Stem Cell Transplantation

Background:Patients with AML are inherently at increased risk of Acute Kidney Injury (AKI) due to multiple reasons including chemotherapy, antibiotics and risk of tumor lysis syndrome (TLS). Prolonged hospital admissions and persistent neutropenia with increased risk of infections necessitate diagnostic testing including computed tomography (CT) scans with contrast. Contrast induced nephropathy (CIN) is a well-known risk of contrast exposure and is a leading cause of hospital acquired AKI. Acute kidney injury is increasingly being recognized as an independent risk factor for survival in patients with hematologic malignancies. To our knowledge, the incidence of CIN in AML patients and its impact on subsequent cancer management has not been studied.Methods:Retrospective chart review of all newly diagnosed AML patients who received inpatient chemotherapy at Seidman Cancer Center from 2004-2017 were included.Out of the 432 patients screened, 223 were excluded as they did not receive any CT imaging. Serum creatinine (S.cr) was documented prior to receiving chemotherapy for induction, consolidation and/or re-induction for relapsed disease. We recorded the highest S.cr during the 2-7 days after undergoing CT with and without contrast, as per the definition of CIN. Outcomes evaluated include hospital length of stay (LOS), transfer to intensive care unit (ICU), need for renal replacement therapy (RRT) and need for changing subsequent management of AML. We also compared the yield of CT without contrast to CT with contrast. Continuous outcomes were evaluated with univariate generalized linear regression models and binary outcomes were evaluated with univariate logistic regression models.Results:Out of the 209 patients included in the study, 255 cycles of chemotherapy were identified where the patient had a diagnostic CT. This includes 191 inductions, 20 consolidations and 39 relapse inductions. Out of the 255 encounters,136 were CT with contrast and 119 without contrast. LOS, transfer to medical ICU, RRT and need for change in AML management was compared in both groups for induction, consolidation and relapse.Baseline characteristics of patients are summarized in Table 1. The co-morbidities contributing to renal dysfunction and concomitant use of nephrotoxic medications were equally prevalent in both groups.Patients with higher creatinine at presentation predominantly had non-contrast CT done (p <0.001). Average length of stay was 36.6 days in non-contrast group compared to 37.0 days in contrast group (p 0.878). There was a slightly increased need for ICU transfer among the patients who received contrast when compared to non contrast group (22 vs 17 days respectively) however this was not statistically significant (p 0.699). There was no significant change in creatinine post contrast exposure compared to the non-contrast group. Interestingly, need for permanent RRT was noticed to be increased in patients who had non-contrast CT compared to the contrast group (4.2% vs 0.7%, respectively). Subsequent treatment change was needed in 9 patients (6.6%) who received contrast and 7 patients (5.9%) in non-contrast group (p 0.822).CT scan was able to yield positive results half the time (50%) in both contrast and non-contrast group. Of note, patients who had non-contrast CT had a slightly higher need for repeat imaging with IV contrast.Conclusion:CT imaging remains the standard of care for diagnosing many of the complications associated with hematologic malignancies such as pulmonary embolus, atypical pulmonary infection and neutropenic enteritis. Patients with AML are prone to develop AKI for numerous reasons. It is important to note that even if it was only a small number of patients who had a need for permanent RRT in our study it was higher in the setting of no contrast exposure, emphasizing the vulnerability of this subgroup of patients to AKI. Even though no permanent unfavorable outcome was associated with IV contrast exposure in our study, any intervention that could potentially increase the risk of AKI still warrants caution and it may be reasonable to start with a non-contrast CT as an initial diagnostic tool. DisclosuresNo relevant conflicts of interest to declare.

P5541Is the classic definition of contrast-induced nephropathy suitable for elderly patients? is renal insufficiency a risk factor?

P5541Is the classic definition of contrast-induced nephropathy suitable for elderly patients? is renal insufficiency a risk factor?

Clinical Implications of Contrast-Induced Nephropathy in Patients Without Baseline Renal Dysfunction Undergoing Coronary Angiography

The clinical implications of different definitions of contrast-induced nephropathy (CIN) in patients without baseline renal dysfunction are not well defined. Consecutive patients at a single centre without baseline renal dysfunction (estimated glomerular filtration rate, eGFR≥60ml/min/1.73m2) undergoing coronary angiography or percutaneous coronary intervention (PCI), were systematically evaluated for long-term risk of mortality following CIN using two broad definitions: an absolute increase from baseline in serum creatinine (SCr) ≥0.3mg/dl (mild to severe absolute CIN) and a relative increase from baseline of 25% (mild to severe relative CIN) within 72hours. Of 2,823 subjects alive before discharge following coronary angiography there were 320 episodes of mild to severe relative CIN (11.3%) and 125 of mild to severe absolute CIN (4.4%). During a median follow-up of 2.3years, 73 patients (3.2%) died. After adjustment for confounders, mild to severe absolute CIN was associated with an adjusted hazard ratio (HR) (95% confidence interval) for all-cause mortality of 3.31 (1.74-6.30) (p<0.0001) and relative CIN with an adjusted HR of 1.92 (1.09, 3.38) (p=0.024). The risk of mortality rose with severity of CIN. Two commonly used definitions of CIN combining absolute and relative terms (increase ≥ 0.3mg/dl or 50%, and ≥ 0.5mg/dl or 25% from the baseline) confirmed these results. Among patients without baseline renal dysfunction undergoing coronary angiography, the incidence of CIN can range widely depending on definition. Absolute CIN is less common than relative CIN. Regardless of definition, CIN is associated with a markedly increased risk of long-term mortality. This finding requires confirmation in multicentre studies.

Effect of Melatonin Administration on Prevention of Contrast- Induced Nephropathy following Coronary Angiography

AbstractIntroduction. Contrast-induced-nephropathy (CIN) is a common complication during angiography that may lead to long-term complications. This study was conducted to investigate the effect of melatonin administration on prevention of CIN in patients who underwent coronary angiography with intra-arterial contrast agents. Method. This is single-blind randomized clinical trial that was performed over 100 patients with indication for coronary angiography. Patients are randomly assigned to two equal groups. All patients in the 12 hours before and 12 hours after the procedure, were received adequate intravenous hydration with normal saline and for the intervention group in addition to hydration, the day before angiography and immediately after angiography 3 mg melatonin was administered. For all patients, serum level of creatinine (Cr), blood urea nitrogen (BUN) and glomerular filtration rate (GFR) before and 48 hours after the procedure were measured. Data were analyzed using SPSS 18 software. Results. Totally 100 participants with the mean age of 64.0±8.2 years were enrolled (63% male). There was no significant difference between intervention and control groups in baseline and demographic characteristics (P&gt; 0.05). Although the mean serum Cr and BUN level increased in both groups, but the mean Cr, BUN and GFR before and after coronary angiography was not statistically significant. Based on the definition of CIN in the current study, 3(6%) patients from intervention group and 2(4%) patients from control group were affected by CIN (P = 0.243). Conclusion. It is likely that, melatonin administration has no significant effect on prevention of CIN following coronary angiography.

CRT-200.03 Prevention Of Contrast Induced Nephropathy By Ischemic Preconditioning In Patients Undergoing Percutaneous Coronary Angioplasty

Contrast-induced nephropathy (CIN) is the acute deterioration of renal function after parenteral administration of radio contrast media in the absence of other causes. The true incidence of CIN is difficult to assess because of differences among the various published studies in the definition of CIN

Incidence of contrast-induced nephropathy a prospective study

Introduction: Contrast-induced acute kidney injury (AKI) is one of the most common causes of hospital-acquired AKI. Objectives: To determine the incidence of contrast induced nephropathy (CIN), to identify significant risk factors associated with CIN and to compare the variations in serum creatinine levels with and without contrast exposure. Patients and Methods: A total of 222 patients (124 males and 98 females with mean age of 48.96 ± 16.74 years) who received iodinated contrast agents during different procedures over a period of 18 months were included in the study. CIN was defined as a relative increase of >25% or an absolute increase of > 0.5 mg/dL in serum creatinine levels 4 days post- procedure. 148 patients (82 males and 66 females with mean age of 47.48 ± 17.21 years) who did not receive any contrast agent were included as controls to determine the frequency with which the variations in serum creatinine levels fulfilled the definition of CIN. Results: The overall incidence of CIN was 12.6%. Incidence of CIN was 32.6% after percutaneous coronary intervention (PCI) and 7.38% after IV contrast exposure (P < 0.0001). Multivariate logistic regression analysis of risk factors revealed heart failure (P = 0.001), pre-procedure serum creatinine level ≥ 1.5 mg/dL (P = 0.005) and nature of contrast agent (P = 0.001), as independent risk factors of CIN. 2.02% patients in control group showed variations in serum creatinine levels within the range corresponding to the definition of CIN. Conclusion: Heart failure, pre-procedural serum creatinine of ≥ 1.5 mg/dL and the nature of contrast agent are independent predictors of CIN.

Incidence and risk factors of contrast-induced nephropathy after diagnostic or interventional coronary angiography

Objectives. Contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure that occurred in the hospital. In Turkey, there is not enough data about the frequency of CIN in cardiological interventions. Increased contrast volume and creatinin value are related with CIN. We also investigated the CIN predictors. Methods. A total of 2604 patients who underwent coronary angiography or percutaneous coronary intervention (PCI) in our hospital were prospectively evaluated in terms of CIN. The definition of CIN includes absolute (≥0.5mg/dl) or relative increase (≥25%) in serum creatinine at 48-72 h after exposure to a contrast agent compared to baseline serum creatinine values. Results. CIN was detected in 13.6% (355 patients) of 2604 patients. According to the procedure; CIN rate was 13.3% (280 of 2108 patients) in coronary angiography, 13.08% (50 of 382 patients) in elective PCI and 21.49% (25 of 114 patients) in primary PCI. Compared with each of these three groups patients, CIN rate was significantly higher in primary PCI group than coronary angiography ( p =0.009) and elective PCI ( p =0.02) groups. In multivariate analysis, age (odds ratio [OR]=1.04; 95% confidence interval [CI], 1.02-1.06; p <0.001), glomerular filtration rate (OR=0.99; 95% CI, 0.98-0.99; p <0.001), contrast volume (OR=1.14; 95% CI, 1.007-1.21; p <0.006), contrast volume to creatinine ratio (OR=1.01; 95% CI, 1.009-1.02; p <0.001), three vessel disease (OR=1.77, 95% CI, 1.24-2.51; p =0.001) were independent predictors of CIN. Conclusions. In our patient population, the incidence of CIN was found to be 13.6% in cardiological interventions. In emergency interventions, incidence of CIN was increased. We found that contrast volume to creatinine ratio is predictor of CIN.

A retrospective evaluation of contrast-induced kidney injury in dogs (2006-2012).

To evaluate a population of dogs for evidence of contrast-induced nephropathy (CIN). A retrospective case review between 2006 and 2012. A university teaching hospital. A total of 1,217 client-owned dogs that were administered intravenous iodinated contrast agents were reviewed for evidence of CIN. Inclusion required a measured serum creatinine within 1 week prior as well as within 1 week following administration of contrast. Eighty-six dogs with 92 contrast administrations qualified for inclusion. None. CIN was defined as an increase in >44.2 μmol/L (0.5 mg/dL) from baseline creatinine concentration within 1 week following administration of an intravenous iodinated contrast agent. A total of 7.6% of contrast administrations (7/92) fulfilled the definition of CIN. The creatinine postcontrast administration as well as the change in creatinine concentration was significantly higher in the CIN group than in the non-CIN group (median postcreatinine 150 μmol/L [1.7 mg/dL] versus 70.7 μmol/L [0.8 mg/dL], median change in creatinine 53 μmol/L [0.6 mg/dL] versus 0 μmol/L). Patient signalment, initial creatinine, number of total contrast administrations, dose of contrast received, duration of anesthesia, IV fluid administration, administration of nephrotoxic agents, and use or vasopressor therapy were not significantly different between groups. The temporal association between contrast administration and renal injury in these cases highlights the potential for CIN in dogs. Due to the retrospective nature of this study, a causal association between contrast administration and renal injury cannot be determined. A prospective study is needed to further evaluate CIN in dogs.

Incidence of persistent renal dysfunction after contrast enhanced coronary CT angiography in patients with suspected coronary artery disease

Contrast-induced nephropathy (CIN) is a potentially serious complication of contrast agents used in computed tomography angiography (CTA). The aim of this study was to evaluate whether persistent renal dysfunction occurs in patients undergoing coronary CTA for suspected stable coronary artery disease (CAD). From a cohort of 957 patients undergone coronary CTA, we identified 402 patients with plasma creatinine levels collected before and within 6months after CTA. According to the definition of CIN, patients with a ≥25 % increase in plasma creatinine after CTA were evaluated. The post-CTA measurements in 402 patients (195 men, age 62.9 ± 9.3years) were performed at a median of 99days after CTA. On average, there was no change in plasma creatinine level between the pre- and post-CTA measurements (75.8 ± 16.0 and 75.7 ± 16.4µmol/L, respectively; P = 0.63) but both increases and decreases were commonly detected. Fourteen (3.5 %) patients had a ≥25 % increase in plasma creatinine levels after CTA. A more detailed evaluation of these patients revealed that in 4 patients the increase was explained by other morbidities, whereas in 9 patients the creatinine level returned to the previous levels at later follow-up (median time to normalization: 311days). Only in 1 (0.2 %) remaining patient, there was a persistent increase in plasma creatinine level, possibly related to the iodine contrast agent exposure. Alterations in plasma creatinine concentration occur frequently. Persistent renal dysfunction attributable to iodine contrast agent exposure is rare in patients referred to coronary CTA for suspected CAD.

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Patients treated by the interventional cardiologist are now older and more frequently have coexistent renal insufficiency than in the past. Exacerbation of renal function can be a serious, morbid complication of cardiac catheterization or intervention and efforts to avoid this untoward event are important to acknowledge. The incidence of contrast-induced nephropathy (CIN) ranges from 2% in patients with normal baseline renal function to as high as 20% to 30% in patients with a baseline creatinine >2 mg/dL.1,2 The most commonly used definition of CIN is an absolute rise in serum creatinine (SCr) of 0.5 mg/dL or a 25% increase from the baseline value, assessed within 48 hours after the procedure.3 Most CIN risk factors can be accessed from clinical history, physical examination, and common laboratory tests. Preexisting chronic kidney disease is probably the most important preprocedural risk factor for CIN. Because an estimated glomerular filtration rate 75 years, advanced heart failure, left ventricular systolic function <45%, and anemia.5,6 Different scoring schemes have been proposed to predict the risk for CIN, but none has been adequately validated. When at-risk patients are identified, various measures can be offered to reduce CIN occurrence. ### Withdrawal of Potentially Nephrotoxic Medications Patients should be advised to withhold all nonessential medications that may be nephrotoxic for 24 hours before the procedure (Table). Although there has been controversy as to whether angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may predispose to nephrotoxicity, a recent study demonstrated no such effect.7 Accordingly, it is reasonable to …

A comparison of definitions of contrast-induced nephropathy in patients with normal serum creatinine.

Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury in hospitalized patients. The prevalence of CIN is reported to range from 0% to 50%, depending not only on patient condition and the procedure used but also the definition of CIN applied. We aimed to determine the best diagnostic indicator of CIN in patients with normal serum creatinine. This study included 206 patients with normal serum creatinine who underwent coronary angiography/angioplasty. Serum creatinine level and glomerular filtration rate (GFR) were measured before and on the second and fifth days after contrast administration. The incidence of CIN based on a 25% increase in serum creatinine was calculated and compared with the incidence based on a 25% decrease in GFR or an increase of at least 0.5 mg/dL in serum creatinine. Of 206 patients, 127 were male (61.7%) and 79 were female (38.3%); the mean age was 59.56±10.3 years. The prevalence of CIN was 30% based on a 25% increase in serum creatinine, 23% based on a 25% decrease in GFR (P<0.012) and 3.8% based on a serum creatinine increase of at least 0.5 mg/dL (P<0.0001). The serum creatinine levels remained within the normal range in the majority of patients with CIN based on the different definitions. In patients with normal serum creatinine, the absolute increase in serum creatinine may describe the prevalence of CIN more accurately than the relative increase in serum creatinine or relative decrease in GFR.

Prediction of contrast-induced nephropathy by the serum creatinine level on the day following cardiac catheterization

BackgroundThe majority of patients who undergo coronary arteriography are discharged from the hospital on the day of the procedure or on the following day. The aim of this study is to investigate whether the change in serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) on the day following cardiac catheterization can predict the development of contrast-induced nephropathy (CIN). MethodsThis is a multicenter prospective observational study, which consists of 860 patients who underwent cardiac catheterization. We measured SCr and eGFR before cardiac catheterization, on the following day, and 48–72h post-procedure. Definition of CIN is changes in SCr ≥0.5mg/dL or ≥25% from baseline 48–72h after contrast exposure. ResultsCIN occurred in 40 patients. SCr levels significantly increased from a baseline of 1.55±1.08mg/dL to 1.79±1.26mg/dL on the following day in patients with CIN (p<0.0001), but significantly decreased from a baseline of 1.21±0.65mg/dL to 1.18±0.61mg/dL on the following day in those without CIN (p<0.0001). eGFR significantly decreased from a baseline of 47.3±28.3mL/min/1.73m2 to 40.6±26.7mL/min/1.73m2 on the following day in patients with CIN (p<0.0001), but significantly increased from a baseline of 53.1±22.0mg/dL to 53.6±21.2mg/dL on the following day in those without CIN (p=0.0236). Receiver operating characteristic curve analysis indicated that SCr change ≥0.1mg/dL [area under the curve (AUC)=0.852, sensitivity 72.5%, specificity 86.1%] and eGFR change ≤−1.1mL/min/1.73m2 (AUC=0.789, sensitivity 85.0%, specificity 64.9%) were the best cut-off values for predicting CIN. Multivariate logistic regression showed that a change in SCr ≥0.1mg/dL [odds ratio (OR), 29.3; 95% confidence interval (CI), 10.8–96.2] and change in eGFR ≤−1.1mL/min/1.73m2 (OR, 69.7; 95% CI, 13.3–952) were powerful independent predictors of CIN. ConclusionsChanges in SCr and eGFR on the day following cardiac catheterization predict the development of CIN.

ASSA14-12-04 Comparison of the efficacy of rosuvastatin versus atorvastatin in preventing contrast induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention

<h3>Objectives</h3> We prospectively compared the preventive effects of rosuvastatin and atorvastatin on contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). <h3>Methods</h3> We enrolled 1078 consecutive patients with CKD undergoing elective PCI. Patients in Group 1 (n = 273) received rosuvastatin (10 mg), and those in group 2 (n = 805) received atorvastatin (20 mg). The primary end-point was the development of CIN, defined as an absolute increase in serum creatinine ≥0.5 mg/dL, or an increase ≥25% from baseline within 48–72 h after contrast medium exposure. <h3>Results</h3> CIN was observed in 58 (5.4%) patients. The incidence of CIN was similar in patients pretreated with either rosuvastatin or atorvastatin (5.9% vs 5.2%, p = 0.684). The same results were also observed when using other definitions of CIN. Clinical and procedural characteristics did not show significant differences between the two groups (p &gt; 0.05). Additionally, there were no significant inter-group differences with respect to in-hospital mortality rates (0.4% vs 1.5%, p = 0.141), or other in-hospital complications. Multivariate logistic regression analysis revealed that rosuvastatin and atorvastatin demonstrated similar efficacies for preventing CIN, after adjusting for potential confounding risk factors (odds ratio = 1.17, 95% confidence interval, 0.62–2.20, p = 0.623). A Kaplan–Meier survival analysis showed that patients taking either rosuvastatin or atorvastatin had similar incidences of all-cause mortality (9.4% vs 7.1%, respectively; p = 0.290) and major adverse cardiovascular events (29.32% vs 23.14%, respectively; p = 0.135) during follow-up. <h3>Conclusions</h3> Rosuvastatin and atorvastatin have similar efficacies for preventing CIN in patients with CKD undergoing PCI.