Higher Incidence Of Contrast-induced Nephropathy Research Articles

Prevention of Contrast-Induced Nephropathy After Cardiovascular Catheterization and Intervention With High-Dose Strong Statin Therapy in Japan - The PREVENT CINC-J Study.

Previous studies have reported that high-dose strong statin therapy reduces the incidence of contrast-induced nephropathy (CIN) in statin naïve patients; however, the efficacy of high-dose strong statins for preventing CIN in real-world clinical practice remains unclear. The aim of this study was to evaluate the efficacy of strong statin therapy in addition to fluid hydration for preventing CIN after cardiovascular catheterization. This prospective, multicenter, randomized controlled trial included 420 patients with chronic kidney disease who underwent cardiovascular catheterization. They were assigned to receive high-dose pitavastatin (4 mg/day × 4 days) on the day before and of the procedure and 2 days after the procedure (Statin group, n=213) or no pitavastatin (Control group, n=207). Isotonic saline hydration combined with a single bolus of sodium bicarbonate (20 mEq) was scheduled for administration to all patients. In the control group, statin therapy was continued at the same dose as that before randomization. CIN was defined as a ≥0.5 mg/dL increase in serum creatinine or ≥25% above baseline at 48 h after contrast exposure. Before randomization, 83% of study participants were receiving statin treatment. The statin group had a higher incidence of CIN than the control group (3.0% vs. 0%, P=0.01). The 12-month rate of major adverse cardiovascular events was similar between the 2 groups. High-dose pitavastatin increases the incidence of CIN in this study population.

The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review.

Iodinated contrast media (ICM) during contrast-enhanced computed tomography (CECT) in the emergency department (ED) is essential to diagnose acute conditions, despite risks of contrast-induced nephropathy (CIN) development and its associated complications. This systematic review aims to evaluate the incidence of CIN and CIN-induced complications, and to explore the relevance of classical risk factors for CIN among ED patients receiving ICM. PubMed, Cochrane, and Web of Science were used on 30 August 2021 to search for peer-reviewed English articles reporting on CIN incidence among ED patients aged ≥18 years who underwent an intravenous CECT. The inclusion criteria included studies that were in English, peer-reviewed, and involved ED patients aged ≥18 years who underwent single intravenous CECT. Studies on intra-arterial procedures and preventive strategies, meta-analyses, clinical guidelines, review articles, and case reports were excluded. The JBI critical appraisal checklist was applied to assess the risk of bias. In total, 18 studies were included wherein 15 were retrospective studies while three were prospective studies. We found a relatively higher CIN incidence in the ED, with variations owing to the CIN definitions. Several classical risk factors including acute hypotension remain linked to CIN onset in ED settings unlike factors such as age and diabetes. While risk of adverse renal events due to CIN is low, there is higher risk of CIN-induced mortality in the ED. Therefore, with the higher incidence of CIN and CIN-induced mortality rates in the ED, ICM administration during CECT in the ED should still be clinically justified after assessing both benefits and risks.

MO415DOES LOW CONTRAST VOLUMES REDUCE RATES OF CONTRAST-INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY?

Abstract Background and Aims Coronary angiography (CAG) necessitates administration of iodinated contrast, which may precipitate an acute deterioration in renal function (contrast-induced nephropathy). Previous work on contrast-induced nephropathy (CIN) has identified contrast volume as a risk factor and suggested that there is a toxic contrast dose above which the risk of CIN is markedly increased. The focus of this study is to provide a critical appraisal of this modifiable risk factor. Method We prospectively enrolled 158 patients who CAG with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department . CIN was defined as an increase in serum creatinine level >25% or 0.5 mg/dL after 48 hours postcardiac catheterization. Toxic contrast dose was defined as a ratio volume of contrast media to estimated glomerular filtration rate (V/eGFR) > 2 . Multivariable regression was conducted to evaluate the effect of exceeding the toxic contrast dose on CIN. Results Of 158 patients (females = 36.1%, mean age 60.0 ± 11 years) who underwent CAG , 15 (9,5%) developed CIN . The volume administered of contrast was not related to the existence of postprocedure CIN (96,6±35,9 ml vs 102,5±33,7ml , p=0,16). However , it was associated with a higher incidence of CIN in patients with chronic renal failure (90±19,1 ml vs 116,6±73,7ml , p=0,008) . The mean V/eGFR value was 1,2±0,7.Nine percent of patients exceeded the toxic contrast dose. After adjusting for other known predictors of CIN, a V/eGFR ratio > 2 remained significantly associated with CIN (odds ratio 4.7, 95% confidence interval 1.28-17.7, P=0,02). Conclusion Low incidences of CIN suggest that a reduced dose of contrast agent is safe in high-risk patients with impaired renal function. A ratio volume of contrast media to estimated glomerular filtration rate > 2 is a significant and independent predictor of CIN after CAG.

Impact of Chronic Kidney Disease on Chronic Total Occlusion Revascularization Outcomes: A Meta-Analysis.

Objectives: To examine the impact of revascularization and associated clinical outcomes of chronic kidney disease (CKD) chronic total occlusion (CTO) and non-CKD CTO groups. Background: The influence of CKD on clinical outcomes after percutaneous coronary intervention (PCI) for CTO lesions is unknown, and there is no systemic review of this topic to date. Methods: We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials Databases for articles published between 1 January 2010 and 31 March 2020. CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease formula. Data included demographics, lesion distributions, incidence of contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success rate, mortality, and target lesion revascularization (TLR)/target vessel revascularization (TVR). Results: Six studies were ultimately included in this systematic review. A high prevalence (25.5%; range, 19.6–37.9%) of CKD was noted in the CTO population. In the non-CKD group, outcomes were better: less incidence of CIN or AKI (odds ratio (OR), 2.860; 95% confidence interval (CI), 1.775–4.608), higher procedural success rate (OR, 1.382; 95% CI, 1.036–1.843), and lower long-term mortality (OR, 4.502; 95% CI, 3.561–5.693). The incidence of TLR/TVR (OR, 1.118; 95% CI, 0.888–1.407) did not differ between groups. Conclusions: In the CKD CTO PCI population, a lower procedural success rate, a higher incidence of CIN or AKI, and higher in-hospital and long-term mortality rate were noted due to more complex lesions and more comorbidities. However, the incidence of TLR/TVR did not differ between groups.

The Role of MicroRNA in Contrast-Induced Nephropathy: A Scoping Review and Meta-Analysis.

Objective Early diagnosis of contrast-induced nephropathy (CIN) remains crucial for successful treatment; unfortunately, the widely used serum creatinine is elevated only in the late stage of CIN. The circulating microRNAs (miRNAs) are stable biomarker that might be useful. The aim of this scoping review and meta-analysis is to assess the role of miRNAs in CIN. Methods We performed a systematic literature search on topics that assess the role of miRNAs in CIN from several electronic databases. Results There were 6 preclinical studies and 2 of them validated their findings in human. Only miR-30a, miR-30c, miR-30e, and miR-188 have been validated in human models. Meta-analysis showed that increase in miR-30a expression was associated with higher incidence of CIN (OR 4.48 [1.52, 13.26], p = 0.007; I2: 94%, p < 0.001). An increase in miR-30e expression was associated with higher incidence of CIN (OR 2.34 [1.70, 3.20], p < 0.001; I2: 0%, p = 0.76). There is an indication that miR-188 is associated with contrast-induced apoptosis and might potentially be a drug target in the future. Conclusion This study highlighted the importance of certain miRNAs in CIN pathophysiology. Future researches should explore on the prognostic and therapeutic implication of miRNA in CIN.

Acute hyperglycemia and contrast-induced nephropathy in patients with non-ST elevation myocardial infarction.

We retrospectively enrolled 281(149, 53% men) NSTEMI patients undergoing PCI. For each patient, plasma glucose levels were secreened at hospital admission. Acute hyperglycemia was defined as glucose levels > 198 mg/dl. CIN was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48-72 hours. Overall, 44 (15.7%) patients had acute hyperglycemia. Patients with acute hyperglycemia had higher incidence of CIN than those without acute hyperglycemia (29.5 vs 5.1%, P < 0.001). Also, in-hospital mortality, length of hospital stay, major bleeding, requirement of mechanical ventilation and dialysis were observed significantly higher in patients with hyperglycemia. Patients were then reallocated to two groups according to the presence or absence of CIN. Overall, 25 cases (8.9%) of CIN were diagnosed. Diabetes mellitus, weight, age, glucose level and estimated glomerular filtration rate (eGFR) were detected as independent risk factors of CIN. Additionally, admission glucose levels were significantly correlated with creatinine levels after PCI, eGFR and contrast volume/eGFR ratio. In NSTEMI patients undergoing primary PCI, acute hyperglycemia may be associated with an increased risk for CIN and in-hospital mortality and morbidity.

Low Contrast Dosage Reduces the Risk of Contrast Induced Nephropathy (Cin): Time for an "Alara" Approach for Contrast Usage at Infrarenal EVAR

Introduction: Contrast induced nephropathy (CIN) is a recognized complication following endovascular aortic aneurysm repair (EVAR) leading to prolonged hospital stay with associated morbidity and mortality. There is insufficient data concerning the renal outcomes and volume of iodinated contrast used during EVAR. We aim to determine the incidence of CIN and to study its relationship to the volume of contrast used based on a conscious decision to minimise the use of iodinated contrast. Methods: A retrospective review of prospectively maintained database of all consecutive patients who underwent infrarenal EVAR by a single surgeon from May 2010 to Dec 2018 was carried out. All complex cases such as chimney/fenestrated/branched procedures were excluded from the study as well as those with incomplete data. Patients were divided into three groups depending upon the volume of contrast used intraoperatively (Group 1: > 100mls, Group 2: 51 - 100mls, Group 3: < 50mls). Data was collected on patient demographics, volume of contrast used intra-operatively, preoperative and postoperative serum creatinine (peak creatinine within 72 hrs post-operatively) and length of hospital stay (LOS). CIN was defined as >25% rise in serum creatinine in the postoperative period 1,2,3. Data was collected in Microsoft Excel and statistically analysed in Minitab 18. Results: A total of 248 patients out of the 290 who underwent EVAR fulfilled the inclusion criteria during the study period. 199 (80.24%) were males. Mean age was 75.3 years (range 48-90, SD + 7.97). Median LOS in groups 1, 2 and 3 was 6 days (IQR 8), 4 days (IQR 4) and 1 day (IQR 2), respectively. Contrast dosage was 148.5±54.5ml in Group 1, 69.7±13.9ml in Group 2, and 32.8+/-12mls in Group 3 [Graph 1]. Overall incidence of CIN was 9.27% (23/248). The incidence of CIN was 18.51% (5/27) in Group 1, 14.85% (15/101) in Group 2and, 2.5% (3/120) in Group 3 [Graph 2]. Incidence of CIN was not statistically different between groups 1 and 2 (p=.77, Fisher exact test), but was significantly lower in group 3 compared to both Group 1 (p< .01) and Group 2 (p< .001). We also noted that Group 1, 2 and 3 corresponded with 3 'eras' of decreasing contrast use: May 2010 - March 2012, Apr 2012 - Sept 2015 and Oct 2015 - Dec 2018, respectively, also corresponding to reduced LOS. However, bivariate logistic regression suggested there was little statistical correlation between LOS and contrast usage (adjusted R-squared = 10.15%). Conclusion: This study demonstrates that larger contrast volumes used during EVAR results in a higher incidence of CIN. LOS decrease throughout the 3 eras is likely multifactorial and not related to contrast usage. We suggest that usage of contrast volume < 50mls is safe and feasible for infrarenal EVAR, and recommend this is essential for reduction of contrast induced nephropathy; we have in fact put this into our current contrast injection regimen as notable from the most recent era of our practice.Graph 2Comparison of incidence of CIN (%).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose

Abstract WP420: Incidence of Contrast Induced Nephropathy Among Different Stroke Subtypes After Adoption of New Emergency Brain Imaging Protocol for Acute Stroke - A Single Center Perspective

Introduction: Studies demonstrating benefits of mechanical thrombectomy for large vessel occlusion (LVO) in acute ischemic stroke (AIS) has led to increased use of CT angiogram (CTA). Similarly, CTA is frequently performed to diagnose cerebrovascular pathology after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Such contrast-enhanced CT (CECT) studies in stroke population are often associated with contrast induced nephropathy (CIN). However, incidence of CIN after adoption of increased use of CTA to diagnose LVO for possible mechanical thrombectomy is largely unknown. Hypothesis: We investigated the incidence of CIN in acute stroke population after adoption of CECT protocol to diagnose LVO and compared it to patients undergoing CECT study for other indications. Methods: Single-center retrospective chart review of patients presenting to the emergency room and investigated with CECT between January 2015 and December 2017. A rise in serum creatinine (SCr) 1.5 times the presenting SCr within first 72 hours of CECT defined CIN. Non-parametric Chi-squared tests were used to make intergroup comparison and a p-value of &lt;0.05 was considered significant. Results: Nine hundred and forty-seven charts of patients undergoing CECT were reviewed. Patients with ICH [30/132 (22.7%)] and SAH [17/126 (13.5%)] had significantly higher incidence of CIN as compared to those with AIS [11/150 (7.3%)] and non-stroke [36/494 (6.8%)] etiologies. Patients developing CIN had increased length of stay in all groups with it being statistically significant in non-stroke (p&lt;0.0001) and ICH (p&lt;0.004). Diabetes mellitus was identified as a significant risk factor for CIN in AIS (p=0.0094) and non-stroke population (p=0.0002). Use of antihypertensives during the first 72 hours of admission was significantly associated with CIN (p=0.0025) among non-stroke patients whereas it was not identified to be a risk factor for CIN in stroke cohort. Intravenous hydration was not associated with prevention of CIN in any of the study groups. Conclusion: Our study results demonstrate higher incidence of CIN among patients with hemorrhagic stroke and reports risk for developing CIN in AIS is comparable to non-stroke population undergoing CECT in emergency circumstances.

Traitement du cœur pulmonaire post-embolique chez le sujet âgé

Aim of the studyTo establish efficacy and security of invasive treatments for chronic thromboembolic pulmonary hypertension (CTEPH) in elderly patients (≥80 years old): pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA). Patients and methodsBetween 2014 and 2017, 549 CTEPH patients were addressed to our hospital for PEA (364 patients) or BPA (225). From this total, patients 80 years old and over were: 17 treated by PEA and 21 by BPA. Demographic characteristics as well as hemodynamic parameters, results and complications were compared for both groups (Young – Y – versus Old – O). ResultsElderly BPA patients presented a higher functional class (mean O: 3,16 versus Y: 2,73; P=0,001), with similar hemodynamics parameters compared with the younger patients. Indication for BPA in the elderly was the presence of comorbidities contraindicating surgery in 33% of cases vs. 9,3% in the younger group (P=0,005). Response to treatment was comparable in both groups with significant reductions of mPAP, PVR and improvement of functional class. Complications rate was alike between groups for hemoptysis, reperfusion lesions or mortality, with the exception of a higher incidence of contrast-induced nephropathy, without need for dialysis, in the elderly group (O: 8,4% versus 2,6%; P=0,010). Elderly PEA patients were more often male (O: 76,5% versus Y: 50,1%; P=0,034) and with a lower creatinine clearance (O: 57,6±13,4 versus Y: 72,2±21,2mL/min/m2; P=0,004). Functional class, hemodynamics, surgical times and in-hospital stay was similar between groups. There is a non-significant trend towards higher in-hospital mortality in the elderly group, ConclusionsIn our experience, treatment of CPC PE in elderly patients, either by PEA or BPA is effective with acceptable complication rates.

Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease.

Contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is associated with adverse outcomes; however, there are scarce data comparing clinical outcomes of post-PCI CIN in ST elevation myocardial infarction (STEMI) patients with and without chronic kidney disease (CKD). We sought to assess the incidence, clinical predictors, and short-term and long-term clinical outcomes of post-PCI CIN in STEMI patients with and without CKD. We performed a retrospective observational cohort study involving 554 patients who underwent PCI for STEMI from February 2010 to November 2013. CKD was defined as estimated glomerular filtration rate ≤60 mL/min and CIN as creatinine increase by ≥25% or ≥0.5 mg/dL from baseline within 72 hours after catheterization contrast exposure. In the entire population, CIN developed in 89 (16%) patients. The incidence of CIN was 19.7% (27/137) in CKD patients and 11.1% (62/417) in non-CKD patients, P < 0.05. Univariate analysis predictors of CIN were older age (65 vs. 60 years), diabetes (35% vs. 21%), peripheral artery disease (11% vs. 5%), cardiogenic shock (24% vs. 13%), hemodynamic support placement (34% vs. 14%), and Mehran score (9.4 ± 7 vs. 5.4 ± 5.2) with all P < 0.05. The predictors of CIN were the same across the CKD and non-CKD cohort with the exception of diabetes. In multivariate analysis, the strongest predictor of CIN in CKD patients was diabetes (odds ratio, 5.8; CI, 1.8-18.6); however, diabetes was not a predictor in the non-CKD population. In the non-CKD population, each single unit increase in the Mehran score was associated with a 1.1 times greater likelihood of CIN (odds ratio, 1.1; CI, 1.01-1.2). Patients with CIN had higher rates of inpatient mortality (14.6% vs. 2.8%), longer length of hospitalization (8 ± 11 vs. 3.4 ± 4.4 days), need for inpatient dialysis (11.2% vs. 0%), higher 30-day mortality (14.6% vs. 3.0%), and higher incidence of long-term serum creatinine >0.5 mg/dL from baseline (16.9% vs. 2.4%) with all P < 0.05. Overall, we found that CKD patients undergoing PCI for STEMI have a higher incidence of CIN than non-CKD patients. CIN confers worse short-term and long-term outcomes irrespective of baseline renal function.

Abstract 12716: Is Pre Existing Atrial Fibrillation a Risk Factor for Contrast Induced Nephropathy After Cardiac Catheterization?

Introduction: Identifying patients at risk is an important step in preventing contrast-induced nephropathy (CIN). Several risk factors have been previously identified. We investigated to determine the association of pre-existing atrial fibrillation (AF) with the development of CIN after cardiac catheterization. Methods: A retrospective chart review of 513 patients who underwent cardiac catheterization from June to December 2014 was done. Patients with end-stage renal disease (n=38) &amp; without pre-procedural serum creatinine (n=57) were excluded. Serum creatinine before the procedure &amp; each day for three days after the procedure was recorded. CIN was defined as an increase in serum creatinine by ≥25% or ≥0.5mg/dl from the pre-procedural value within 72 hours of contrast exposure. Chronic kidney disease (CKD) was defined as eGFR &lt;60ml/min calculated by modified diet in renal disease equation. Use of ICD 9 codes for atrial fibrillation &amp; congestive heart failure (CHF) in admission medical records was defined as pre-existing AF &amp; CHF. Results: A total of 418 patients (mean age 69.1 ± 13.8, 55% male and 45% female) were included in the study. 13% of patients had pre-existing AF, 27.9% had CHF &amp; 19.6% had CKD. 16 patients of the total 418 developed CIN. The mean incidence of CIN in the population studied was 3.8%. Higher incidence of CIN was seen in AF, CHF &amp; CKD groups when tested by univariate analysis &amp; chi-squared test. The incidence of CIN was 13.8% in AF group Vs. 2.3% in non-AF group (p&lt;0.001), 8.6% in CHF group Vs. 1.9% in non-CHF group (p&lt;0.01) &amp; 8.9% CKD group Vs. 2.4 % in non-CKD group (p&lt;0.002). In multivariate logistic regression analysis, development of CIN was strongly associated with pre-existing AF. AF had odds ratio (OR) 4.11, 95% confidence interval (CI) 1.40-12.07, p=0.01. CHF had OR = 2.67, 95% CI, 0.89-7.98, p=0.08. CKD had OR=3.94, 95% CI, (1.56-9.98), p=0.04. Conclusions: Pre-existing atrial fibrillation may have an association with higher risk of CIN after cardiac catheterization in addition to conventional risk factors.

Predicting contrast induced nephropathy post coronary intervention: A prospective cohort study

Abstract Objective The purpose of our study was to assess the incidence and predictors of contrast induced nephropathy (CIN) in unselected patients undergoing coronary intervention either coronary angiography (CA) or percutaneous coronary interventions (PCI), at Assiut university hospitals. Background CIN is a frequent, potentially lethal complication after coronary intervention. It is the 3rd most common cause of hospital-acquired acute renal failure. Patients and methods This is an observational prospective cohort study. Two hundred consecutive patients between December 2011 and August 2012 underwent CA and PCI were enrolled in the study. Blood samples were collected at baseline and 3 days after interventions. All patients were followed up for 2 weeks for major adverse events. Results CIN was observed in 23 (11.5%) patients. According to Mehran risk score, 84.5% of our patients had low risk for CIN, 15.5% had moderate risk for CIN, and no one had high risk score. Multivariate logistic regression analysis of predictors for CIN, showed that the use of high osmolar contrast media (CM) (Telebrix) was associated with 4 times higher incidence of CIN than the use of low osmolar CM (Ultravest) (OR = 4.07; 95% CI = 1.1–15.1). None of our patients had clinical signs or symptoms of acute renal failure, or required haemodialysis at 2 weeks of follow up. Conclusion Although most of our study population was at low risk, the incidence of CIN was relatively high due to the use of high osmolar CM. Further studies are needed for cost effectiveness in light of negligible clinical impact.

Role of Hydration in Contrast-Induced Nephropathy in Patients Who Underwent Primary Percutaneous Coronary Intervention

To investigate the role of hydration to prevent contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI), we prospectively included 408 consecutive patients who were randomly assigned to receive either hydration with isotonic saline (1 ml/kg/h since the beginning of the procedure and for 24 hours after it: NS+ group) or not (NS- group). All patients received an iso-osmolar nonionic contrast medium. The primary end point was the development of CIN: ≥25% or ≥0.5 mg/dl increase in serum creatinine within 3 days after the procedure. CIN was observed in 14% of patients: 21% in the NS- group and 11% in the NS+ group (p=0.016). CIN was significantly associated with death (15.2% vs 2.8%; p<0.0001) and need for dialysis (13.4% vs 0%; p<0.0001). In multivariate analysis, the only predictors of CIN were hydration (OR=0.29 [0.14 to 0.66]; p=0.003) and the hemoglobin before the procedure (OR=0.69 [0.59 to 0.88]; p<0.0001). In conclusion, intravenous saline hydration during PPCI reduced the risk of CIN to 48%. Patients with CIN had increased mortality and need for dialysis. Given the higher incidence of CIN in emergent procedures, and its morbidity and mortality, preventive hydration should be mandatory in them unless contraindicated.

Lower Blood Vitamin D Levels Are Associated With an Increased Incidence of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography

BackgroundVitamin D deficiency may be associated with an increased risk of renovascular disease. We assessed the correlation between vitamin D levels and contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG). MethodsVitamin D and parathyroid hormone (PTH) levels were assessed before CAG in 403 patients. Estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault equation. Patients with eGFR < 60 mL/min/1.73 m2 were hydrated with 0.9%-saline at 1 mL/kg/h for 12 hours before and after CAG. CIN was defined as serum creatinine increase of > 0.5 mg/dL or > 25% within 48-72 hours after CAG. ResultsCIN developed in 74 participants. Baseline eGFR, blood urea and creatinine in CIN (+) and (−) groups were not significantly different (P = 0.14, P = 0.07, and P = 0.61, respectively). Total volume of contrast medium (CM) was higher in the CIN (+) group (132 ± 64 mL vs 90 ± 41 mL; P = 0.01). Vitamin D levels were lower (median 8.5 [range, 0.5-26.6] ng/mL vs 14.9 [range, 1.9-93.5] ng/mL; P = 0.01) and PTH levels were higher (median 73.9 [range, 22-530] pg/mL vs 44.2 [range, 5-361] pg/mL; P = 0.01) in the CIN (+) group. Multivariate logistic regression analysis revealed that lower vitamin D levels (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.11-1.26; P = 0.01) and increased CM volume (OR, 1.01; 95% CI, 1.008-1.017; P = 0.01) were independently correlated with CIN. In patients who had undergone percutaneous coronary intervention, lower levels of vitamin D were independently associated with CIN development. ConclusionsLower vitamin D levels, implying possible vitamin D deficiency, are associated with a higher incidence of CIN.

E-016 Risk of Contrast-Induced Nephropathy Following High Dose of Contrast Media in Patients Undergoing Neuroendovascular Procedures

BackgroundWe report the incidence and risk factors for contrast-induced nephropathy (CIN) after the use of high dose radio contrast media (RCM), defined as 250 ml or greater, during neuroendovascular procedures.Materials...

Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

PurposeThe purpose of this study was to assess the effect of anemia on the incidence of contrast-induced nephropathy (CIN) in patients with renal impairment undergoing MDCT. Materials and methodsInstitutional review board approval was waived for this retrospective review of 843 patients with stable renal insufficiency (eGFR between 15 and 60mL/min) who had undergone contrast-enhanced MDCT. Baseline hematocrit and hemoglobin values were measured. Serum creatinine (SCr) was assessed at the baseline and at 48–72h after contrast administration. ResultsThe overall incidence of CIN in the patient population with renal insufficiency was 6.9%. CIN developed in 7.8% (54 of 695) of anemic patients, and in 2.8% (4 of 148) of non-anemic patients (P=.027). After adjustment for confounders, low hemoglobin and low hematocrit values remained independent predictors of CIN (odds ratio 4.6, 95% CI 1.0–20.5, P=.046). ConclusionsAnemia is associated with a higher incidence of CIN in patients with renal insufficiency. Anemia is a potentially modifiable risk factor for CIN, and has an unfavorable impact on prognosis in patients with renal insufficiency undergoing contrast-enhanced MDCT.

Hyperuricemia may be related to contrast-induced nephropathy after percutaneous coronary intervention

Dear Editor, We have read with great interest the recently published article titled, “The relationship between hyperuricemia and the risk of contrast-induced nephropathy after percutaneous coronary intervention in patients with relatively normal serum creatinine”, by Yong Liu et al. (1). In that well-presented paper, the authors investigated the value of hyperuricemia in predicting the risk of contrast-induced nephropathy (CIN) in patients with relatively normal serum creatinine who are undergoing CIN. They demonstrated that CIN might develop in patients with normal creatinine levels. Hyperuricemia is a significant and independent predictor of CIN after percutaneous coronary intervention (PCI) and results in significantly increased in-hospital mortality and CIN incidence, which requires renal replacement therapy after PCI. Thus, despite having normal baseline creatinine levels, patients with hyperuricemia, an intra-aortic balloon pump, emergent PCI, or older age should receive more comprehensive renal prophylaxis to reduce the occurrence of CIN. CIN has been recognized as a serious complication of PCI and may cause increased morbidity and mortality. CIN is one of the most important reasons for hospital-acquired renal failure and can cause prolonged hospitalization, increased cost and incidence of renal and cardiovascular events, and mortality. Elderly patients have a higher risk of CIN because of decreased renal reserve. In addition, some factors, such as an estimated glomerular filtration rate (eGFR) of 200 mL have been identified as risk factors for CIN after PCI (2). Additionally, alcohol consumption and the arterial blood pressure level before contrast exposure may be associated with CIN. Hypertriglyceridemia, metabolic syndrome, an impaired fasting glucose level, and multivessel disease may also be associated with a higher incidence of CIN (3). Some medications, including renin-angiotensin-aldosterone system medications, may also be related to CIN (4). It would have been interesting for the authors to provide information about these factors in this study. Finally, the authors used the Cockcroft-Gault equation to measure eGFR. The Cockcroft-Gault equation may underestimate eGFR in younger age groups and may overestimate eGFR in older individuals compared with the Modification of Diet in Renal Disease (MDRD) formula (5). Although the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently published an equation for eGFR using the same variables (serum creatinine level, age, sex, and race) as the MDRD formula, the CKD-EPI equation more accurately categorized individuals with respect to long-term clinical risk (6). In addition, even mild chronic kidney dysfunction, defined as an eGFR <90 mL/min, and dehydration were risk factors for CIN. For this reason, it may be useful to include the results using the CKD-EPI equation and accounting for mild chronic kidney dysfunction and dehydration as risk factors for CIN.

Neutrophil-to-Lymphocyte Ratio May Predict Contrast-Induced Nephropathy

We read with interest the article ‘‘Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention’’ by Kaya et al. They investigated the relationship between neutrophilto-lymphocyte (N/L) ratio and contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI). They demonstrated a relationship between N/L ratio and CIN development in patients with STEMI undergoing primary percutaneous coronary intervention. They also demonstrated an independent association between N/L ratio and CIN development in patients with STEMI undergoing coronary angiography. A full blood count is a cheap method that provides information about red and white cells, platelets, count and dimensions of subgroups of cells, and parameters like red cell distribution width, platelet cell distribution width, and mean platelet volume. Routine peripheral blood counts may be useful in risk stratification of patients with CIN. The white blood cell (WBC) count is one of the inflammatory biomarkers. Although the WBC may be within the normal range, subtypes of WBC, as expressed by the N/L ratio, may predict all-cause mortality. The N/L ratio is an easy, cheap, noninvasive, and widely available laboratory marker used to evaluate systemic inflammation. The N/L ratio has received increased attention due to its role as an independent prognostic factor for coronary artery disease (CAD), hypertension, chronic kidney disease, diabetes, heart failure, cerebrovascular disease, peripheral arterial disease, and malignancy. It can also be affected by atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolemia, metabolic syndrome, nonalcoholic liver disease, abnormal thyroid function tests, and older age. Furthermore, acute bacterial and viral infections may change the N/L ratio. Additionally, medications such as antihypertensive therapy including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, b-blockers, and statins may influence the N/L ratio. It would be useful and the results might be different, if the authors described these factors. The CIN is a serious complication of PCI. The CIN is one of the most important reasons of hospital-acquired renal failure. The CIN can cause prolonged hospitalization, increased cost and incidence of renal and cardiovascular events, and mortality. Elderly patients are at greater risk of CIN because of decreased renal reserve. In addition, some factors like glomerular filtration rate (GFR) 200 mL were identified as risk factors for CIN after PCI. Alcohol consumption and arterial blood pressure before contrast exposure may be associated with increased risk of CIN in patients. Hypertriglyceridemia, metabolic syndrome, impaired fasting glucose, and multivessel disease may also be associated with the higher incidence of CIN. Also, some medications including a renin–angiotensin–aldosterone system medications may be related to CIN. Finally, they used the Cockcroft-Gault equation to calculate the GFR. The modification of diet in renal disease (MDRD) is another method for calculating the GFR. However, the Cockcroft-Gault equation may estimate lower GFR in younger age groups compared with the MDRD formula, but it can measure higher GFR in older individuals compared with the MDRD formula. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recently published an equation for GFR using the same variables (serum creatinine level, age, sex, and race) as the MDRD formula. However, the CKD-EPI equation more accurately categorized individuals with respect to longterm clinical risk of incident end-stage renal disease, all-cause mortality, coronary heart disease, and stroke compared with the MDRD formula. In addition, even mild chronic kidney dysfunction such as a GFR <90 mL/min and dehydration was also a risk factor for CIN. In conclusion, these findings will enlighten further studies about N/L ratio as a surrogate marker of risk stratification in

A prospective study on the risk of contrast induced nephropathy in the patients who underwent contrast-enhanced CT examination

Objective To investigate the incidence of contrast induced nephropathy (CIN) among different patient groups after contrast agent injection. Methods A total of 1243 patients were included in this study (male=694,female=549).The SCr level one week before and 72 hours after the CT examination and the incidence of CIN were recorded and comparison was made among groups according to sex,age,body mass index (BMI),the history of high blood pressure (HBP),diabetes mellitus (DM),chronic kidney disease (CKD),chronic heart failure (CHF),tumor,nephrotoxicity drug (NTD) usage.The frequency,type,dose and injection velocity of the contrast media (CM) were also recorded.Multivariate predictors of CIN were identified by Logistic regression using step-wise selection with entry and exit criteria of P<0.10,results were tabulated as odds ratios (OR) with 95% confidence intervals (CI). Results Among 1243 consecutive patients,the incidence of CIN was 5.5% (68/1243).Patients with a history of HBP,DM,CHF,CKD or tumor presented with higher incidence of CIN than that of controls (5.9%,51/868 vs.4.5%,17/375).CIN developed in 9 of 203 patients (4.4%,9/203) with CKD and in 59 of 1040 patients (5.7%,59/1040) without CKD.There was no significant difference between the two groups (χ2=0.51,P=0.30).In CKD (-) group,the incidence of CIN was higher in females,patients with DM and patients using LOCM than those of males,DM (-) and using low osmolality contrast medium (IOCM) (P 1). Conclusion Women,age≥75 years,LOCM,NTD,tumor,and the frequency of using CM more than once per month were more likely to develop CIN. Key words: Contrat media; Kidney insufficiency; Statistics

高齢患者における造影剤腎症の検討

Aging is an established risk factor for contrast-induced nephropathy (CIN). However, little information is available on the incidence and clinical outcome of CIN for the elderly patients in Japan. We determined the incidence and clinical outcome of CIN in the Japanese elderly patient. We studied 292 patients who had mild renal dysfunction (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2)) at baseline and underwent coronary angiography. Patients were divided into two groups base on their age: the elderly group (age ≥ 75, n=108) and the control group (age<75, n=184). CIN was defined as a 25% increase in serum creatinine or an increase in serum creatinine by>0.5 mg/dl above the baseline value at or within 2 days post procedure. Patients in the elderly group had a higher incidence of CIN (14%) than those in the control group (9%). In patients who developed CIN, there was no significant difference between the two groups in baseline GFR and GFR on days 1, 2, 7 and 30 after the procedure. However, the relative increase in GFR above baseline on day 7 (-4.0 ± 6.1 vs -8.3 ± 8.0 ml/min P=0.096) and day 30 (1.5 ± 9.4 vs -10.1 ± 9.6 ml/min P=0.0017) in the elderly group was higher than that in the control group. Furthermore, death occurred in 3 patients in the elderly group (20%) whereas no patient died in the control group (P=0.092). Aging (age ≥ 75) is a risk factor for CIN in Japanese. CIN in the elderly patients may be associated with prolonged renal dysfunction and poor prognosis.