Independent Risk Factors For Contrast-induced Nephropathy Research Articles

Abstract P131: Effect of uncontrolled systolic blood pressure in hypertensive patients as a risk factor for CIN after coronary angiography with preventative management of CIN : single center prospective study

Background: Contrast induced nephropathy(CIN) is associated with poor outcomes like dialysis and prolonged hospitalization and risk of death. Clinical factor for CIN include advanced age, diabetes (DM), female, heart failure(HF) and hypertension(HTN). Many prophylaxis strategies for CIN(normal saline hydration, N-acetylcysteine, NAHCO3) had been studied and their preventive effects had been known to be no difference. Purpose: We tried to evaluate the effects of uncontrolled systolic blood pressure(defined as SBP>160mmHg) in hypertensive patients as a risk factor for CIN after coronary angiography(CAG) with various preventative management of CIN (normal saline hydration, N-acetylcysteine, NAHCO3). Methods: This study included 41patients who performed CAG combined with various preventative management of CIN in single center. All patients were evaluated with serum creatinine(SCr), creatinine clearance(CrCl) before and after coronary angiography at day0, day1, day2 and day30. Definition of CIN include; SCr increase of ≥0.5 mg/dL, a SCr increase ≥25%, an CrCl decrease of ≥25%, or the composite, occurring 48 to 72 hours after contrast exposure. We also analyzed preexisting renal insufficiency(GFR<60ml/min), DM and HTN, age, sex, anemia, contrast volume and HF which are known risk factors for CIN. Results: 11 of 41 patients developed CIN. There was no statistical differences between the two groups in the aspect of baseline Cr, age, sex, body weight, contrast volume and the prevalence of known risk factor for CIN (DM, HTN, HF and preexisting renal failure). Mean baseline SBP in the CIN group was higher than non-CIN group(166.3±31.9 vs142.4±25.7, P-value=0.018). Among 23 patients with HTN, 11 patients (47.8%) had uncontrolled SBP. The multivariable logistic regression analysis showed that an uncontrolled SBP (odds ratio [OR] 12.63, 95% confidence interval [CI] 1.83-87.07) was the independent risk factor for CIN. Conclusions: CIN associate with variety of short-term and long-term complication after CAG. Hypertension is well known as one of the risk factors for CIN. Even if appropriate preventative management of CIN are taken before and after CAG, uncontrolled SBP in hypertensive patients could increase the risk of CIN.

Evaluation of contrast induced nephropathy related risk factors and long-term results.

We aimed to evaluate the frequency of contrast induced nephropathy (CIN), its relationship with accepted risk factors and long-term renal outcomes in patients who underwent coronary angiography (CAG). All patients who underwent CAG between April 2020 and April 2021 were retrospectively evaluated. CIN was defined as characteristic increase in serum creatinine after CAG. CIN developed in 50 (5.4%) of 934 patients. The CIN rate was found to be statistically significantly higher in patients with diabetes, hypertension, heart failure and those using diuretics. Pre-procedural hemoglobin, albumin and GFR were found to be independent risk factors for CIN. After discharge, the urea and creatinine values of the patients who developed CIN were significantly higher than those who did not. We concluded that in order to reduce the development of CIN, hemoglobin and albumin levels should be evaluated with renal functions before the procedure and they should be kept within normal limits.

Different hydration methods for the prevention of contrast-induced nephropathy in patients with elective percutaneous coronary intervention: a retrospective study

BackgroundHydration is currently the main measure to prevent contrast-induced nephropathy (CIN). We aimed to compare the preventive effect of preprocedure and postprocedure hydration on CIN in patients with coronary heart disease undergoing elective percutaneous coronary intervention (PCI).MethodsA retrospective study included 198 cases of postprocedure hydration and 396 cases of preprocedure hydration using propensity score matching. The incidence of CIN 48 h after PCI and adverse events within 30 days after contrast media exposure were compared between the two groups. Logistic regression analysis was used to analyse the risk factors for CIN.ResultsThe incidence of CIN in the postprocedure hydration group was 3.54%, while that in the preprocedure hydration group was 4.8%. There was no significant difference between the two groups (p = 0.478). Multivariate logistic regression analysis showed that diabetes mellitus, baseline BNP and cystatin C levels, and contrast agent dosage were independent risk factors for CIN. There was no significant difference in the incidence of major adverse events between the two groups (3.03% vs. 2.02%, p = 0.830).ConclusionsPostprocedure hydration is equally effective compared to preoperative hydration in the prevention of CIN in patients with coronary heart disease undergoing elective PCI.

The Value of C-reactive Protein/Albumin Ratio in the Prediction of Contrast-Induced Nephropathy in Emergency Department Patients.

Contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure in hospitalized patients and is an important cause of prolonged hospital stay, morbidity, and mortality. We aimed to investigate the effectiveness and sufficiency of the prognostic capacity of the inflammatory biomarkers C-reactive Protein (CRP) and albumin ratio (CAR) in predicting the development of CIN in patients undergoing contrast-enhanced computed tomography (CT) imaging in the emergency department (ED). This study was performed on patients whose laboratory values ​​could be reached within 48 hours after contrast-enhanced CT imaging in the emergency department of our hospital. The patients were divided into two groups as those with and without CIN according to their increased creatinine levels. Its effectiveness in detecting the development of CIN in the early period was evaluated comparatively. One hundred and twenty-five patients were included. CIN developed in 10.4% of the patients. The CAR was 0.19 (IQR: 0.17-0.33) in the group with CIN and 0.02 (IQR: 0.01-0.06) in the group without CIN; and the difference between the two groups was significant (p<0.001). In multivariate logistic regression analysis, it was found that the CAR increased as an independent risk factor for CIN (OR: 2.326; 95% CI: 1.39-3.893; p=0.001). We think that early identification of patients who may develop CIN through the CAR in EDs and early initiation of treatment for CIN may affect the morbidity-mortality rate and reduce the duration of hospitalization and treatment costs.

The triglyceride-glucose index and contrast-induced nephropathy in non-ST elevation myocardial infarction patients undergoing percutaneous coronary intervention.

The triglyceride glucose (TyG) index is an indicator of insulin resistance and associated with increased risk of diabetes mellitus and cardiovascular events. Our study investigates the correlation between TyG index and contrast induced nephropathy (CIN) in non-diabetic patients with non-ST elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). 350 non-diabetic NSTEMI patients (183, 52.3% male) undergoing PCI were retrospectively enrolled. The enrolled cohort was divided into 2 groups based on the calculated TyG index, namely values < 8.65 or higher. CIN was defined as an increase in serum creatinine > 25% or 0.5 mg/dL from baseline in the first 48 to 72 hours after PCI. A total of 56 (16%) cases of CIN were diagnosed. In contrast to patients with lower TyG indexes, patients with higher TyG indexes (≥8.65) had a higher frequency of CIN, 9.5%. versus 20.8% respectively (P .004). Patients with CIN also had higher TyG indexes (8.74 ± 0.12 vs 8.67 ± 0.11, P < .001). In addition, TyG index, age, and glomerular filtration rate were identified as independent risk factors for CIN in logistic regression model (OR: 2.5 CI: 1.3-4.6, P .006, OR: 1.0 CI: 1.0-1.1, P < .001, OR: 1.0 KI: 1.03-1.06, P .025). In the ROC analysis, the area under the curve predictive of CIN was 0.666 (P < .001, 95% [CI] 0.58-0.75) with a cutoff value of 8.69 (sensitivity 71,4%, specificity 55.1%) TyG index. Higher TyG indexes are associated with an increased risk of CIN in non-diabetic patients with NSTEMI.

The Effect of Fluorescein Angiography on Renal Function: A Meta-analysis and Systematic Review

Background. Contrast-induced nephropathy (CIN) is a complication that occurs in patients undergoing an imaging procedure with intravenous injection of contrast media, most notably iodinated dyes. Fluorescein angiography is a diagnostic procedure performed by ophthalmologists to determine abnormalities in retinal blood vessels. It uses sodium fluorescein, an organic dye, to capture and visualize these blood vessels. There have been conflicting data and practices on how to approach the procedure especially in patients with renal insufficiency. Objective. To determine the risk of CIN among patients undergoing fluorescein angiography. Methods. We searched PubMed, HerdIn, Cochrane Library, and Google Scholar, for published articles on the topic. Other sources were searched for unpublished data or ongoing clinical trials. All research articles pertaining to fluorescein angiography and its effect on renal function with serum creatinine monitoring were included. Two independent authors separately screened records, assessed full texts, and extracted data. We used RevMan computer software to analyze data from the included studies. The primary outcome was the risk of CIN among patients undergoing fluorescein angiography based on the differences on serum creatinine levels and estimated glomerular filtration rates pre- and post-angiography, while the secondary outcome included risk factors for CIN. Results. A total of 6 studies were included in the meta-analysis. Four studies had poor quality as assessed using the Newcastle-Ottawa Scale. One study was deemed to have good quality. Data analysis showed that hemoglobin (p = 0.002) and albumin (p &lt; 0.001) levels may be associated with CIN using sodium fluorescein but were not independent risk factors for CIN (multivariable logistic regression, p = 0.648 and p = 0.069, respectively); while sex, diabetes mellitus and chronic kidney disease were not significantly associated. As a primary outcome, only 6.8% of included patients had CIN with serum creatinine levels post-exposure showed significant differences from baseline values (mean difference 0.05; 95% CI 0.02, 0.07; I2 = 49%), but translating it to eGFR yielded non-significant differences (mean difference -0.37; 95% CI -2.33, 1.59; I2 = 0%). Conclusion. Among patients undergoing fluorescein angiography, sodium fluorescein does not pose an increased risk for CIN.

Incidence And Risk Factors Of Contrast Nephropathy After Tace In Patients With Liver Cancer And Chronic Kidney Disease.

Incidence of contrast induced nephropathy (CIN) and related risk factors in patients with liver cancer and chronic kidney disease after trans-catheter arterial chemoembolization (TACE) is higher. The purpose of this study was to investigate the feasibility and safety of TACE therapy in such patients. A retrospective analysis was performed on 103 patients with liver cancer and chronic kidney disease who underwent TACE treatments. TACE was performed according to Seldinger's technique of arterial embolization with minor modifications. Based on CIN diagnostic criteria, patients were divided into non-CIN (n=89) and CIN (n=14) groups. Multiple clinical parameters were assessed for the two groups after TACE. Serum creatinine levels were measured 48-72 h after TACE. Tumor size (>5 cm), TACE frequency, contrast agent dosage, solitary kidney, volume of iodized oil used in the TACE (ml) and urea levels were significantly higher in CIN group in comparison with the non-CIN group, while serum albumin and haemoglobin levels were significantly lower. Multivariate logistic regression analysis confirmed that the volume of iodized oil and TACE frequency were significantly positively correlated, and serum albumin level was negatively correlated in the CIN group. Volume of iodized oil, TACE frequency and low serum albumin levels were found to be independent risk factors for CIN after TACE. Thus, it is safe and feasible for hepatocellular carcinoma patients with chronic kidney disease to receive TACE treatment, but adverse events management after TACE needs to be addressed.

Predictive value of post-procedural hyponatremia on contrast-induced nephropathy in patients who underwent coronary angiography or percutaneous coronary intervention

Objective Hyponatremia is a prognostic marker for specific pathologies. However, the association between contrast-induced nephropathy (CIN) and post-procedural hyponatremia has not been explored. Our study aims to evaluate the association between hyponatremia developing after contrast media administration and CIN. Material and methods A total number of 236 patients who required nephrology consultation before coronary angiography (CAG) or percutaneous coronary intervention (PCI) because of the high risk for contrast nephropathy, were included. Serum sodium levels were measured at admission and within three consecutive days after contrast media administration. Results Hyponatremia was observed in 141patients (59.7%) following angiography. CIN was developed in 149 (63.4%) patients. Among the patients who developed hyponatremia, ejection fraction, serum haemoglobin level and serum albumin level were low whereas, contrast media volume and percentage of the diabetes mellitus were higher. Also, length of hospital stay, percentage of CIN, renal replacement requirement and mortality rate were higher in patients with hyponatremia. In univariable analysis to evaluate the risk factors for CIN, being female gender, age, diabetes mellitus, serum albumin concentration, haemoglobin level, contrast media volume and hyponatremia were associated with development of CIN. Multivariable logistic regression analysis revealed that advanced age, serum albumin concentration and hyponatremia were independent predictors of CIN. Conclusion Post-procedural hyponatremia was an independent risk factor for CIN in CAG or PCI patients.

The Predictive Value of Myeloperoxidase for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction.

BackgroundHigher serum myeloperoxidase (MPO) in patients with acute coronary syndrome is associated with adverse cardiovascular outcomes. Contrast-induced nephropathy (CIN) is associated with worse prognosis in patients with coronary artery disease following angiography. We have no idea whether patients with higher serum myeloperoxidase have a higher risk of CIN in acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).MethodsThis study involved 436 consecutive patients with AMI who had received PCI. Serum MPO levels were determined using enzyme-linked immunosorbent assay before administration of contrast media. Multivariate logistic regression analysis was used to analyze the independent risk factors for CIN after univariate analysis. The receiver operator characteristic (ROC) analysis was performed to evaluate the predictive value of MPO for CIN.ResultsAmong the 436 patients, 79 individuals (18.1%) suffered CIN after the PCI procedure. Patients who developed CIN had significantly higher MPO levels compared to those who did not ([203.8 (150.6–276.2)] versus [138.5 (129.9–149.2)]; p<0.001). Multivariate logistic regression analysis revealed that MPO level (OR 1.023, 95% CI: 1.017–1.029, p<0.001) was an independent risk factor for the incidence of CIN after adjusting for the baseline information, blood indicators and angiography procedural parameters. The area under the ROC curve for predicting CIN of MPO was 0.848, and the optimum cutoff point of MPO was 147.38ug/L; the sensitivity and specificity were 82.3% and 72.3%, respectively.ConclusionThe results show that MPO is independently associated with an increased risk of CIN with AMI patients undergoing PCI. Further studies are needed to verify these results.

The relationship between serum endocan levels with the presence of contrast-induced nephropathy in patients undergoing coronary angiography

Aim:Contrast-induced nephropathy (CIN) is associated high mortality and morbidity risks in the patients undergoing coronary angiography (CAG).Endocan, a new endothelial dysfunction biomarker, could be a potential immunoinflammatory biomarker for CIN.We investigated the possible association between serum endocan levels and CIN in the patients undergoing CAG. &#x0D; Material and Methods:We prospectively enrolled 92 patients undergoing CAG.For each patient, serum endocan levels were assessed at hospital admission before CAG.Contrast-induced nephropathy was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48 - 72 hours. &#x0D; Results:Overall, 32 cases (34.8%) of CIN were diagnosed.There were no significant differences between the two groups (CIN and without-CIN) in demographic data and general risk factors. 38 patients (41%) were performed percutaneous coronary intervention. Patients with CIN had higher serum endocan levels (3.68 ng/dl;IQR, 0.78-17.3 vs 1.81 ng/dl;IQR, 0.19-17.4, p:0,002) than patients without CIN. Additionaly; basal glomerular filtration rate, contrast volume, serum endocan level and left ventricle ejection fraction were detected as independent risk factors of CIN (p= 0.014, B:0.94, CI: 0.89-0.98, p= 0.024, B:2.55, CI:1.13-5.77, p= 0.026, B:2.45, CI:1.11-5.42, p= 0.044, B:0.91, CI:0.83-1.43, respectively). &#x0D; Conclusion:In patients undergoing CAG, high serum endocan levels could be associated with an increased risk for CIN.

Predictive value of preprocedural albuminuria for contrast-induced nephropathy non-recovery in patients undergoing percutaneous coronary intervention

Abstract Background The degree of renal recovery from contrast induced nephropathy (CIN) may affect long-term outcomes. Albuminuria had been generally considered to be an independent risk factor of CIN. However, the predictive value of albuminuria for CIN non-recovery in patients undergoing percutaneous coronary intervention (PCI) remains unknown. Purpose To evaluate the association of preprocedual albuminuria and CIN non-recovery after PCI. Methods From January 2012 to December 2018, 550 consecutive patients developing CIN after PCI and reassessing kidney function among 1 to 12 months were enrolled. CIN non-recovery was defined as a relative decrease of serum creatinine ≥25% or 0.5 mg/dl over baseline at 1 to 12 months in patients who developed CIN. Patients were stratified into three groups according to urinary albumin: negative group (urine dipstick negative), trace group (urine dipstick trace) and positive group (urine dipstick ≥1+). Results Overall, 88 (16%)patients had trace urinary albumin, 74 (13.5%) patients had positive urinary albumin and 40 (7.3%) patients developed CIN non-recovery. Patients with positive urinary albumin had significantly higher incidence of CIN non-recovery [negative (3.4%), trace (11.4%) and positive (23.0%), respectively; P&amp;lt;0.0001]. Multivariate analysis showed that trace and positive urinary albumin were associated with an increased risk of CIN non-recovery (trace vs. negative: OR: 2.879, P=0.022; positive vs negative: OR: 2.991, P=0.021). Conclusion Preprocedural albuminuria was associated CIN non-recovery in patients undergoing PCI. Incidence of CIN non-recovery Funding Acknowledgement Type of funding source: None

Glycemic variability as predictor of contrast-induced nephropathy in diabetic patients with acute myocardial infarction undergoing percutaneous coronary intervention.

BackgroundContrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI). Diabetes mellitus (DM) and acute myocardial infarction (AMI) are associated with an increased risk of CIN. However, it remains unclear whether glycemic variability (GV) has the important prognostic significance of CIN in diabetic patients with AMI undergoing PCI. We conducted this study to investigate the independent prognostic value of the in-hospital GV in diabetic patients who presented with AMI and were treated with PCI.MethodsThe study group comprised 252 diabetic patients with AMI who underwent PCI and were assigned to CINand non-CIN groups. A continuous glucose monitoring system (CGMS) was used to determine the mean amplitude of glycemic excursion (MAGE), a representative index of GV. Independent risk factors for CIN were determined by multivariate logistic regression analysis (MLRA), and receiver-operating characteristic (ROC) analysis was used to measure the prognostic potential of GV.ResultsA total of 55 patients had CIN and they showed markedly elevated MAGE compared with the non-CIN group. MLRA revealed that MAGE had potential to independently predict CIN. The area under the ROC curve, optimal cut-point value, sensitivity and specificity for MAGE were 0.739, 2.95, 70.91% and 61.42%, respectively.ConclusionsIn diabetic AMI patients undergoing PCI, high GV is associated with increased risk of CIN.

Monosit/yüksek-dansiteli lipoprotein oranının st elevasyonu olmayan miyokard enfarktüslü hastalarda kontrasta bağlı nefropatiyle ilişkisi

Aim: Contrast-induced nephropathy (CIN) is associated with worse prognosis in patients with non-ST-elevation myocardial infarction (NSTEMI). Early identification patients with a high risk of CIN are very crucial to improve outcomes. The monocyte to high-density lipoprotein ratio (MHR) is a novel inflammatory marker. We aimed to investigate the MHR had a predictive role for CIN development in patients with NSTEMI. Material and Methods: NSTEMI who underwent percutaneous coronary intervention (PCI) were included in the study. MHR was calculated and CIN was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48- 72 hours. Results: A total of 370(200, 54.1% men) patients were included in this study and 104 (28.1%) of them had DM. 25 (6.7%) of patients had CIN. MHR was significantly higher in patients with CIN (0.014± 0.004 vs 0.011± 0.006-respectively, p: 0.017). MHR was also significantly correlated with creatinine levels after PCI (r:0,104, p: 0.047). CIN group also experienced a more complicated in-hospital clinical course. Additionally; weight and MHR were detected as independent risk factors of CIN in logistic regression analysis.Conclusion: Preprocedural MHR may be used as cheap, easy and simple marker of CIN. It may help with the early identification of patients with NSTEMI who are at high risk of 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.

Role of serum cystatin C in the prediction of contrast-induced nephropathy after intra-arterial interventions.

BackgroundThe diagnosis of contrast-induced nephropathy (CIN) is usually based on changes in serum creatinine (sCr). However, sCr has poor sensitivity as a biomarker of kidney injury. The aim of this study was to investigate the usefulness of serum cystatin C (sCysC) to predict CIN after intra-arterial interventions.MethodsA total of 360 consecutive patients underwent intra-arterial procedures using digital subtraction angiography. SCr, sCysC, and estimated glomerular filtration rate were measured at 1 to 2 days before and at 48, 72 h, and 7 days after the procedure.ResultsThirty-one patients (8.61%) developed CIN. Receiver operating characteristic (ROC) curve analysis showed that pre-operative sCysC levels had good discriminatory power (area under the curve [AUC] = 0.634; 95% confidence interval [CI] = 0.526–0.743) for evaluating the risk of CIN after an endovascular procedure, with a sensitivity of 53.33% and specificity of 73.70%. ROC analysis showed that sCysC at 48 h after contrast medium administration was predictive of CIN after an endovascular procedure (AUC = 0.735; 95% CI = 0.647–0.822) with satisfactory sensitivity of 74.20% and specificity of 63.90%. Diabetes mellitus was an independent risk factor for CIN (odds ratio = 2.778; 95% CI = 1.045–7.382; P = 0.040).ConclusionsSCysC is an appropriate biomarker to predict the occurrence of CIN. Baseline sCysC before an intervention is useful to obtain a preliminary estimate of the risk of CIN. A 48-h cut-off value of sCysC of 0.99 mg/L after an endovascular procedure may help to rule out patients at lower risk of CIN.

Fibrinogen-to-Albumin Ratio Predicts Contrast-Induced Nephropathy in Patients after Emergency Percutaneous Coronary Intervention.

Background The aim of the present study was to investigate the association between fibrinogen-to-albumin ratio (FAR) with contrast-induced nephropathy (CIN) in patients undergoing emergency percutaneous coronary intervention (PCI). Methods 565 patients with emergency PCI were consecutively enrolled. The primary outcome was CIN defined as either a 25% increase in baseline serum creatinine levels or a 0.5 mg/dL (44 μmol/L) increase in absolute serum creatinine levels within 72 h after the contrast medium exposure. Logistic regression analysis was applied to analyze whether FAR was an independent risk factor for CIN. Results Overall, 29 (5.1%) patients developed CIN. Compared with the patients without CIN, the patients developing CIN had lower albumin (39.79 ± 3.95 vs. 37.14 ± 5.21, P=0.012) and higher fibrinogen levels (3.51 ± 0.94 vs. 4.14 ± 0.96, P < 0.001). In the multivariate logistic analysis, FAR was an independent predictor of CIN (OR = 3.97; 95% CI, 1.61–9.80; P=0.003) along with perihypotension, age >75 years, and LVEF <45%, and 0.106 was the optimal cutoff value of preprocedural FAR to predict CIN. Conclusion Preprocedural levels of FAR were associated with CIN in patients after emergency PCI.

The Ratio of Fibrinogen to Albumin as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography.

Contrast-induced nephropathy (CIN) is acute kidney failure that occurs after exposure to contrast agent. There is no sensitive biomarker to predict the development of CIN. In a retrospective study, we investigated the predictive value of the fibrinogen to albumin ratio (FAR) to determine the risk of CIN in patients (N = 246) who underwent carotid angiography. Contrast-induced nephropathy was defined as a 0.5 mg/dL or 25% increase in serum creatinine levels 48 to 72 hours following exposure to a radiocontrast agent. Patients were grouped according to whether they developed CIN or not, that is, CIN(-) and CIN(+) groups, respectively. Contrast-induced nephropathy developed in 39 (15.8%) of all the patients. The fibrinogen levels, neutrophil to lymphocyte ratio (NLR), and FAR in the CIN (+) group were higher than in the CIN (-) group ( P < .001). Multivariate analysis showed that age, diabetes, NLR, platelet-lymphocyte ratio, and FAR were independent risk factors for CIN. The area under the curve (AUC) of FAR was 0.800 for the prediction of CIN, and the best cutoff value was 57.4 with sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 60.8%, 26.4%, and 92.7%, respectively. The FAR may be useful as a predictor of CIN.

Effect of Enalapril-folic acid tablet on development of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with coronary heart diseases complicated with mild renal insufficiency

Objective To explore the impact of Enalapril-folic acid tablet on development of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in elderly patients with coronary heart diseases(CHD) complicated with mild renal insufficiency. Methods A total of 935 old patients (≥60 years) undergoing selective PCI at our hospital from January 2013 to June 2016 were enrolled in this retrospective study.Based on treatments during the perioperative phase, the 935 patients were divided into Enalapril-folic acid tablet intervention group (n=296, 31.7%), and other RAS blocker control group with Angiotensin eonverting-enzyme inhibitor (ACEI) or Angiotensin Ⅱ receptor blocker (ARB) (n=639, 68.3%). The levels of serum creatinine for 72 hours after operation were monitored and evaluated.Baseline data and CIN incidence were compared between two groups.The clinical events within 1 month after contrast media application were recorded.Multivariate Logistic regression analysis was used to analyze independent risk factors for CIN after PCI. Results The incidence of CIN after PCI was lower in the intervention group than in the control group with no statistical significance[7.1% (21/296) vs.11.1% (71/639), χ2=3.679, P=0.059]. Multivariate regression analysis showed that age (OR=1.103, P=0.001), hypertension (OR=3.362, P=0.017), and hyper-homocysteinemia (OR=3.528, P=0.003) were independent risk factors, but the treatment with Enalapril-folic acid tablet might be a protective factor for development of CIN after PCI (OR=0.443, P=0.042). During the 1-month follow-up, the rate of recurrent angina pectoris was lower in the intervention group than in the control group (P 0.05). Conclusions The treatment with enalapril-folic acid tablet may prevent the occurrence of CIN after PCI in elderly patients with coronary heart disease and mild renal insufficiency. Key words: Enalapril; Folic acid; Cysteine; Nephrosis; Contrast media

Risk factors of contrast-induced nephropathy in patients with acute myocardial infarction treated with emergent percutaneous coronary intervention

Objective To explore the risk factors of contrast-induced nephropathy (CIN)in patients with acute ST-segment elevation myocardial infarction(STEMI)treated with emergent percutaneous coronary intervention(PCI). Methods The clinical data of patients with STEMI treated by emergent PCI from January 2014 to February 2017 in Peking University People’s Hospital was reviewed. Exclusion criteria included contrast agent allergy, previous renal diseases, chronic renal failure, heart failure, tumor, acute infection, only one renal function test available during hospitalization and lacking essential medical records. Data of demographics, past medical history, general conditions at admission, laboratory findings, etc, were collected. Patients were divided into CIN group and non-CIN group. The univariate comparison analysis and Logistic regression analysis were performed to obtain the risk factors of CIN. Results A total of 236 patients were enrolled. The incidence of CIN was 10.2% (24/236). Univariable analysis demonstrated that the risk factors of CIN were age, diabetes mellitus, Killip grade ≥ 3 stage, serum uric acid (SUA) level at admission, blood glucose level at admission. Binary logistic regression analysis showed that SUA≥350 μmol/L at admission, blood glucos≥11 mmol/L at admission, age≥75 years were independent risk factors for CIN. Conclusion SUA≥350 μmol/L at admission, blood sugar≥11 mmol/L at admission, age≥75 years were independent risk factors of CIN in patients with STEMI treated with emergent PCI. Key words: Acute ST-segment elevation myocardial infarction; Contrast-induced nephropathy; Risk factors

Growth differentiation factor-15 levels and the risk of contrast induced nephropathy in patients with acute myocardial infarction undergoing percutaneous coronary intervention: A retrospective observation study.

AimsTo investigate the association between growth differentiation factor-15 (GDF-15) and contrast-induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).MethodsA total of 311 patients with AMI were studied retrospectively. All patients were divided into two groups according to the occurrence of CIN after PCI. Baseline clinical data were compared between two groups. Multivariate logistic regression analysis was used to identify the risk factors for CIN. Cox regression analysis was used to identify the association between GDF-15, CIN and short-term outcome.ResultsThere were 80 patients in CIN group (average age was 71.60 ± 13.00 years; 67.5% male) and 231 patients in non-CIN group (average age was 63.80 ± 11.70 years; 71.9%male). The concentration of GDF-15 in CIN group was higher than that of non-CIN group (1232 ± 366.6 ng/L vs. 939.20 ± 309.6 ng/L, P <0.001). According to GDF-15 quartiles, patients were divided into four groups. Multivariate logistic model indicated that the highest quartile(Q4) was significantly associated with an increased risk of CIN compared with lower level of GDF-15 (Q1, Q2 and Q3) (OR : 3.572, 1.803–7.078, P < 0.001). Of 243 patients who could calculate the ACEF risk score, area under the curve (AUC) of GDF-15 was 0.793, 95%CI: 0.729–0.856, P < 0.001, while AUC of ACEF was 0.708, 95%CI: 0.630–0.786, P < 0.001. Using 10% and 30% as arbitrary thresholds to define patients at low, intermediate, and high risk, GDF-15 achieved a net reclassification improvement (NRI) of 0.32 (95%CI: 0.123–0.518, P = 0.001) compared with the ACEF risk score. Cox regression model showed that high concentration of GDF-15 (Q4) was significantly associated with an increased risk of all-cause mortality and major adverse clinical events (MACE) (HR: 8.434, 95%CI: 2.650–26.837, P <0.001; HR: 3.562, 95%CI: 1.658–7.652, P = 0.001) compared with low level of GDF-15 (Q1, Q2 and Q3). CIN was an independent predictor of all-cause mortality and MACE in AMI patients (HR: 3.535, 95%CI: 1.135–11.005, P = 0.029; HR: 5.154, 95%CI: 2.228–11.925, P <0.001).ConclusionGDF-15 levels increased in CIN group in AMI patients underwent PCI. GDF-15 was an independent risk factor for CIN in AMI patients underwent PCI. GDF-15 level and CIN are independent risk factors for all-cause mortality and MACE in short-term follow-ups.