Outcome Of Contrast-induced Nephropathy Research Articles

Incidence, Predictors and Outcomes of Contrast Induced Nephropathy in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Background:Contrast induced nephropathy (CIN) is considered one of the most common causes of hospital acquired renal failure and severely affects morbidity and mortality. Our objective was to investigate incidence, predictors and outcomes of CIN in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Methods:The study was conducted on 550 patients with STEMI subjected to PPCI. Patients were classified into two groups according to the occurrence of CIN; group I (Patients without CIN) and group II (Patients with CIN). The two groups were assessed for the clinical outcomes including mortality and major adverse cardiac events (MACE).Results:Incidence of CIN was 10.6%, multivariate regression analysis identified the independent predictors of CIN including; age > 60 years OR 6.083 (CI95% 3.143–11.77, P = 0.001), presence of diabetes mellitus OR 2.491 (CI95% 1.327–4.675, P = 0.005), non-steroidal anti-inflammatory drugs (NSAIDs) use OR 2.708 (CI95% 1.393–5.263, P = 0.003), the volume of contrast agent >200 ml OR 6.543 (CI95% 3.382–12.65, P = 0.001) and cardiogenic shock OR 4.514 (CI95% 1.738–11.72, P = 0.002). Mortality was higher in group II than group I (11.9% vs. 4.4% respectively, P = 0.015). The incidence of MACE were higher in group II than group I (heart failure; 18.6% vs. 7.3%, cardiac arrest; 8.5% vs. 2.8% and cardiogenic shock; 16.9% vs. 6.9% with P. value = 0.003, 0.024, 0.007 respectively).Conclusion:Contrast induced nephropathy was associated with increased morbidity and mortality. The independent predictors of CIN were advanced age, diabetes mellitus, NSAIDs use, the volume of contrast agent >200 ml and cardiogenic shock.

TCTAP A-056 Incidence, Predictors and Clinical Outcome of Contrast-induced Nephropathy Among the Patients Undergoing Coronary Angiogram with or without Percutaneous Coronary Intervention within 24 Hours for Acute ST Elevated Myocardial Infarction, Admitted to Cardiology Unit, National Hospital Sri Lanka

TCTAP A-056 Incidence, Predictors and Clinical Outcome of Contrast-induced Nephropathy Among the Patients Undergoing Coronary Angiogram with or without Percutaneous Coronary Intervention within 24 Hours for Acute ST Elevated Myocardial Infarction, Admitted to Cardiology Unit, National Hospital Sri Lanka

Abstract 12964: Complete Revascularization of Stable Patients Presenting With STEMI is Associated With Decreased Cardiovascular Death and Reinfarction If Performed During Index Percutaneous Coronary Intervention, but Not If Complete Revascularization is Staged

Introduction: Recent evidence suggests that complete revascularization (CR) of stable patients presenting with STEMI improves outcomes, but the appropriate timing of said CR has not been clearly established (CR during index PCI [iCR] versus staged CR [sCR]). sCR is defined as CR within a mean of 31.5±24.6 days after the STEMI. Objective: To determine the appropriate timing of CR for it to be beneficial (iCR versus sCR). Methods: A systematic review of Medline, Cochrane, and Embase was performed for randomized control trials (RCTs) that reported outcomes of stable patients presenting with STEMI and whose culprit lesion received PCI, who were subsequently randomized into culprit-lesion only and CR cohorts. Only RCTs with at least a 12-month follow-up were included. The timing of CR, for the subdivision of CR cohort into iCR and sCR, had to be stated. Seven RCTs comprising 6647 patients (mean age: 62.9±1.4 years, male sex: 79.4%) met this criteria and were included. Results: After a mean follow-up of 25.1±9.4 months, iCR, when compared to a culprit-lesion only strategy, was associated with a significant cardiovascular mortality benefit (Risk Ratio [RR] 0.48 95% Confidence Interval [CI] 0.26-0.90 p=0.02, Relative Risk Reduction [RRR] 52%) and a significant decrease in reinfarctions (RR 0.42 95% CI 0.25-0.70 p=0.001 RRR: 58%). sCR showed no significant benefit for any of the studied outcomes when compared to a culprit-lesion only strategy. There was no significant difference in all-cause mortality or in the composite safety outcome of contrast-induced nephropathy nor stroke in either the iCR or the sCR groups when compared to the culprit-lesion only group. Conclusion: Complete revascularization during index PCI of stable patients presenting with STEMI, but not staged CR, is associated with a statistically significant decrease in cardiovascular death and non-fatal reinfarctions. There is no difference between groups in all-cause mortality or in the composite safety outcome.

Prevalence and outcome of contrast-induced nephropathy in major trauma patients

BackgroundContrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN.MethodsBetween 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence.ResultsOf 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN.ConclusionCIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.

Contrast-induced nephropathy following CT scan for trauma is not rare and is associated with increased mortality in South African trauma patients

Acute trauma patients are at risk for the development of acute kidney injury (AKI). One potential nephrotoxic agent, which a trauma patient may be exposed to, is iodinated contrast media (ICM). We aim to review the incidence and outcome of contrast-induced nephropathy (CIN) in trauma patients in a busy trauma service, and to identify potentially modifiable risk factors. During the period from December 2012 to April 2017, all patients who underwent a contrast-enhanced CT scan for trauma were included. Data were examined and outcome data were reviewed. A total of 1566 patients required a CT scan following blunt trauma at our institution. Of this total 755 patients underwent a contrast-enhanced CT scan. There were 173 females (22.9%) and 582 males (77.1%). All these patients received intravenous contrast. A total of 143 (18.9%) were admitted to ICU, and 58 (7.7%) of patients died. Detailed electrolyte studies pre- and post-procedure were available for 312 patients. Of these 312 patients, 46 developed CIN (14.7%).There was no difference in the incidence of pre-CT AKI or deranged electrolytes between the patients who developed CIN and those who did not. The development of CIN was associated with an increased risk of death as well as increased need for renal replacement therapy as well as increased need for ICU. Contrast-induced nephropathy is a real risk in trauma patients undergoing contrast-enhanced CT scan for blunt trauma in our environment. Further work is needed to define and delineate risk factors.

The Incidence, Risk Factors, and Outcomes of Contrast-Induced Nephropathy In Patients With Critical Limb Ischemia Following Lower Limb Angiography

Intra-arterial digital subtraction angiography (DSA) is commonly used for the diagnosis and treatment of patients with critical limb ischemia (CLI). The aim of this study was to analyze the incidence of contrast-induced nephropathy (CIN) in patients with CLI and to assess their outcomes. Between May 2013 and May 2014, a prospective and observational study was conducted with 107 patients admitted exclusively for CLI treatment. The main outcomes included hemodialysis independence (HI) and overall survival (OS), as assessed by Kaplan-Meier curves. Overall, there was a predominance of males (57%), with a mean age of 70.5 (10.7) years. The incidence of CIN was 35.5%, and chronic kidney failure was the only factor associated with elevated risk of this condition (relative risk [RR] = 1.9; 95% confidence interval = 1.17-3.09; P = .017). The median follow-up was 645 days, and in 720-day analyses, patients who experienced CIN had worse HI (81.2% vs 96.3%; P = .0107) and OS (49.5% vs 66.3%; P = .0463). The current study found a high incidence of CIN in patients with CLI after DSA. This renal impairment was associated with a worse prognosis in terms of survival.

Abstract WP34: Prevalence and Predictors of Endovascular Treatment-related Nephropathy in Acute Ischemic Stroke Patients: an Analysis of the Acute Stroke Due to Intracranial Atherosclerotic Occlusion and Neurointervention Korean Retrospective (ASIAN KR) Registry

Background and Purpose: As endovascular therapy (EVT) occupies a growing role in the management of acute ischemic stroke (AIS), contrast-induced nephropathy (CIN) associated with consecutive contrast media administration for vascular imaging and distal subtraction angiography is an emerging concern. We investigated the incidence, risk factors and clinical outcome of CIN in AIS patients who underwent EVT. Methods: Multicenter data from the ASIAN KR registry collected between January 2011 and Mar 2016, on consecutive patients who received EVT for AIS, were analyzed. Diagnostic criteria for CIN were: an absolute increase in serum creatinine (SCr) by ≥0.3 mg/dL from baseline within 48 hours after EVT; or a relative increase in SCr levels by ≥50% from baseline. Results: Of 721 patients, 616 patients (85%) were eligible for this study. CIN was diagnosed in 47 (7.6%), and was more associated with history of hypertension (p=0.011), history of diabetes mellitus (DM) (p=0.002), and higher initial NIHSS score (16.6 vs. 18.7 p=0.006). In multivariable analysis, independent risk factors of CIN were hypertension history (OR 2.465, 95% CI 1.027-5.919, p=0.043), DM history (1.978, 1.023-3.822, p=0.042), initial NIHSS score (1.071, 1.014-1.132, p=0.014), initial SCr level (1.603, 1.159-2.217, p=0.004) and duration from puncture to final angiography (1.006 per minute, 1.000-1.012, p=0.045). In multiple logistic regression, CIN was an independent risk factor of poor clinical outcome (modified Rankin Scale at 3 months 4-6; 3.782, 1.770-8.083, p=0.001) after adjusting age, sex, initial NIHSS, hypertension history, DM history, onset to puncture time and successful reperfusion. Conclusions: CIN is not uncommon and associated with poor clinical outcome after EVT in AIS. Clinicians should be aware that key factors associated with an increased likelihood of CIN are hypertension history, DM history, abnormal SCr level, higher NIHSS score and longer procedure duration.

Renal assessment using CKD-EPI equation is useful as an early predictor of contrast- induced nephropathy in elderly patients with cancer.

To assess respective roles of serum creatinine (SCr) alone and estimated glomerular filtration rate (eGFR) as an early predictor for contrast-induced nephropathy (CIN) in elderly patients with cancer. eGFR of 348 patients at 65years or older with malignancy who underwent contrast-enhanced computed tomography (CECT) were calculated. eGFR was calculated based on the following three equations: Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI); Modification of Diet in Renal Disease Study (MDRD); Cockcroft-Gault (CG). CIN was subdivided into two groups: CIN25% (SCr increase >25% but ≤0.5mg/dl), and CIN0.5 (SCr increase >0.5mg/dl). The occurrence and clinical outcomes of CIN were determined according to SCr and eGFR. After CECT, CIN occurred in 50 (14.4%) patients, including 33 CIN25% patients and 17 CIN0.5 patients. CIN0.5 was significantly correlated with prolonged hospitalizations and increased in-hospital mortality, but not CIN25%. Despite SCr<1.5mg/dl, preexisting renal insufficiency (RI) was observed in 47 (13.5%) patients based on CKD-EPI equation, 50 (14.4%) patients based on MDRD equation, and 144 (41.4%) patients based on CG formula. In preexisting RI, the prevalence of CIN0.5 had an odds ratio of 15.02 (5.24 to 43.07) based on CKD-EPI equation, 13.73 (4.81 to 39.20) based on MDRD equation, and 5.03 (1.60 to 15.75) based on CG formula. In elderly patients with cancer who visit the emergency department, renal assessment before CECT using CKD-EPI equation was superior to SCr alone, MDRD equation, or CG formula in predicting the occurrence of CIN related CECT.

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Despite ranking third as a cause of hospital-acquired acute kidney injury (AKI), iatrogenic contrast-induced nephropathy(CIN) impacts significantly on morbidity and mortality and is associated with high hospital costs. In sub-Saharan Africa, the rates and riskfactors for CIN and patient outcomes remain unexplored. We conducted a prospective observational study at the Charlotte Maxeke Johannesburg Academic Hospital, South Africa, from1 July 2014 to 30 July 2015. Hospitalised patients undergoing computed tomography scan contrast media administration and angiography wereconsecutively recruited to the study and followed up for development of AKI. CIN was defined as an increase in serum creatinine&gt;25% or an absolute increase of &gt;44 μmol/L from baseline at 48 - 72 hours post exposure to contrast media. Outcome variables were theoccurrence of CIN, length of hospitalisation and in-hospital mortality. We recruited 371 hospitalised patients with a mean (standard deviation) age of 49.3 (15.9). The rates of CIN, assessed using an absolute orrelative increase in serum creatinine from baseline, were 4.6% and 16.4%, respectively. Anaemia was an independent predictor for the developmentof CIN (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.01 - 2.87; p=0.04). The median serum albumin was 34 g/L (interquartile range (IQR)29 - 39.5) and 38 g/L (IQR 31 - 42) in the CIN and control groups, respectively (p=0.01), and showed a significant trend for CIN development(RR 1.68, 95% CI 0.96 - 2.92; p=0.06). Mortality was significantly increased in the CIN group (22.4% v. 6.8%; p&lt;0.001), and CIN together withanaemia increased mortality twofold (RR 2.39, 95% CI 1.20 - 4.75; p=0.01) and threefold (RR 3.32, 95% CI 1.48 - 7.43; p=0.003), respectively. CIN has a relatively high incidence in sub-Saharan Africa and predicts poorer clinical outcomes. The presence of CIN and anaemiapositively predicted mortality. Caution should be exercised in patients with hypoalbuminaemia and anaemia undergoing contrast media administration.

Parkinsonian tremor-induced electrocardiographic artifacts mimicking atrial flutter/fibrillation or ventricular tachycardia

[1] McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 1997;103:368–75. [2] McCullough PA, Stacul F, Becker CR, et al. Contrast-induced nephropathy (CIN) consensus working panel: executive summary. Rev Cardiovasc Med 2006;7:177–97. [3] Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int 1995;47:254–61. [4] Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004;44:1393–9. [5] Iakovou I, Dangas G, Mehran R, et al. Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention. J Invasive Cardiol 2003;15:18–22. [6] Rao SV, Cohen MG, Kandzari DE, Bertrand OF, Gilchrist IC. The transradial approach to percutaneous coronary intervention: historical perspective, current concepts, and future directions. J Am Coll Cardiol 2010;55:2187–95. [7] Baklanov DV, Kaltenbach LA, Marso SP, et al. The prevalence and outcomes of transradial percutaneous coronary intervention for ST-segment elevation myocardial infarction: analysis from the National Cardiovascular Data Registry (2007 to 2011). J Am Coll Cardiol 2013;61:420–6. [8] Vuurmans T, Byrne J, Fretz E, et al. Chronic kidney injury in patients after cardiac catheterisation or percutaneous coronary intervention: a comparison of radial and femoral approaches (from the British Columbia Cardiac and Renal Registries). Heart 2010;96:1538–42. [9] Scolari F, Ravani P, Gaggi R, et al. The challenge of diagnosing atheroembolic renal disease: clinical features and prognostic factors. Circulation 2007;116:298–304.

Impact of sex on the risk to develop contrast-induced nephropathy after transcatheter aortic valve implantation.

Contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure and is associated with increased morbidity and in-hospital mortality. Some recent studies identified female sex as a risk factor of CIN. The aim of this study was to determine the relative impact of female sex on the development and clinical outcome of CIN in patients with preexisting renal impairment after transapical transcatheter aortic valve implantation (TAVI). From February 2008 to February 2011, a total of 55 TAVI patients [82.4 (6.5) years] with preprocedural serum creatinine level of greater than 1.1 mg/dL were retrospectively investigated. The incidence of postprocedural CIN, lengths of intensive care unit and hospital stay, and short-term mortality among men and women were compared. Contrast-induced nephropathy was defined as a creatinine increase of greater than 0.5 mg/dL or greater than 25% from baseline within 3 days after contrast medium (CM) exposure. The women had significantly lower body surface area [1.8 (0.18) vs 1.95 (0.17) m2; P = 0.002), lower hemoglobin levels [11.5 (1.3) vs 12.7 (1.6) g/dL, P < 0.001], and lower estimated glomerular filtration rate [34.2 (9.7) vs 49.4 (12.3) mL/min per 1.73 m2, P = 0.002]. The amount of CM given was significantly higher in the women relative to body surface area [67.3 (42.5) vs 48.3 (16.6) mL/m2, P = 0.043]. The women received a higher number of blood cell transfusion units [4.4 (3.4) vs 2.1 (2.7) U, P = 0.006]. The frequency of CIN within 72 hours after CM exposure was significantly higher in the women (62.1% vs 26.9%, P = 0.009). A total of 31% of the women (n = 9) versus 7.7% of the men (n = 2) needed hemodialysis (P = 0.031). Analysis of the postoperative morbidity in terms of length of intensive care unit and hospital stay revealed no significant difference between the two groups. Mortality results reached a significant difference at 60 days, with 31% (n = 9) mortality in the women compared with 7.7% (n = 2) in the men (P = 0.031). Women with preexisting renal impairment are at higher risk than men for CIN, with resultant higher early mortality after transapical TAVI.

Incidence and outcomes of contrast-induced nephropathy in adult ICU patients

Critically ill patients cared for in ICUs often require radiological investigation using iodinated contrast agents. Contrast- induced nephropathy (CIN) - a form of acute kidney injury (AKI) - is a complication following the use of such contrast. Although CIN has been thoroughly studied in some populations (for example, those undergoing coronary angiography), it has not been investigated in large numbers of ICU patients [1].

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.

GRACE Risk Score Predicts Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome and Normal Renal Function

We evaluated the incidence, clinical predictors, and outcomes of contrast-induced nephropathy (CIN) after coronary angiography in patients with myocardial infarction and normal kidney function. We studied 202 consecutive patients with glomerular filtration rate >60 mL/min/1.73 m(2). The CIN was defined according to 3 definitions: increases in serum creatinine (sCr) ≥25%, ≥0.3 mg/dL, and ≥0.5 mg/dL. The CIN occurred in 56 (27.7%), 42 (20.8%), and 13 (6.4%) patients, respectively. In multivariate analysis, the presence of a high Global Registry of Acute Coronary Events (GRACE) risk score (>140) was an independent predictor of CIN in its milder forms (≥25% and ≥0.3 mg/dL of rise in sCr). Increase in sCr ≥0.3 mg/dL was an independent predictor of bleeding. Increase in sCr ≥0.5 mg/dL was an independent predictor of in-hospital cardiac events (mortality, myocardial infraction [MI], and heart failure). As conclusion, the GRACE score is a useful tool to predict CIN in patients with MI and normal renal function.

Defining Incidence and Outcome of Contrast-Induced Nephropathy Among Trauma: Is It Overhyped?

Contrast-induced nephropathy (CIN) in trauma patients is uncommon and the incidence is unknown. We studied the incidence of CIN and its outcome. A retrospective chart review of trauma patients 16 years of age and older who were admitted to our Level I trauma center during 2005 was performed. Patients who received the intravenous contrast CT scan and had their serum creatinine (Cr) monitored at admission and at 48 to 72 hours were identified. CIN was defined as a 0.5-mg/dL rise of serum Cr or a 25 per cent increase from the baseline if the baseline Cr was abnormal. We excluded patients transferred from an outside facility, patients without repeated serum Cr measurements, patients who had cardiac arrest or persistent hypotension, and patients who had received N-acetylcysteine (Mucomyst) before their CT scan. We compared CIN and non-CIN groups. During 2005, 543 fit our study criteria, of whom 19 (3.5%) had CIN. CIN (vs non-CIN) had a higher baseline serum Cr (1.48 + 0.23 vs 1.06 + 0.02, P < 0.001), a longer intensive care unit stay (17 vs 5 days, P < 0.001), and a longer hospital stay (19 vs 8 days, P < 0.001); the mortality rate was not different (10 vs 4%, P = 0.2). We found elevated baseline serum Cr (OR, 1.92; 95% CI, 1.13 to 3.27; P = 0.016) to be associated with increased risk for CIN. All but two serum Cr levels peaked within 48 hours; all returned to baseline. One patient with an underlying congenital kidney disease required temporary dialysis. CIN incidence in trauma is low and the clinical course is benign.

Effect of contrast-induced nephropathy on cardiac outcomes after use of nonionic isosmolar contrast media during coronary procedure

Contrast-induced nephropathy (CIN) has been increasing and seems to be associated with clinical outcomes in ischemic heart disease. This study aimed to assess the incidence, predictors, and cardiac outcomes of CIN when nonionic isosmolar contrast media (iodixanol, Visipaque(®), GE Healthcare, Cork, Ireland) was used. Between January 2005 and July 2008, 510 patients (69.2 ± 9.0 years of age, 384 men) undergoing diagnostic coronary angiography (CAG) or percutaneous coronary intervention (PCI) were divided into two groups according to the development of CIN (CIN group: n=74; non-CIN group: n=436). CIN developed in 74 patients (14.5%). They were more likely to have diabetes (55.4% vs. 42.9%, p=0.045), decreased left ventricular ejection fraction (LVEF) (50.1 ± 12.6% vs. 57.7 ± 13.9%, p<0.001), and lower baseline hematocrit level (32.4 ± 5.3% vs. 36.6 ± 5.5%, p<0.001). Multiple logistic regression analysis revealed baseline hematocrit (odds ratio 0.900, 95% confidence interval 0.851-0.952, p<0.001), decreased LVEF (odds ratio 0.967, 95% confidence interval 0.949-0.986, p=0.001), and baseline creatinine level (odds ratio 2.317, 95% confidence interval 1.252-4.286, p=0.007) as independent predictors of CIN. At 1-year follow-up, patients with CIN were found to have more adverse outcomes than without CIN in Cox proportional hazards analysis (hazard ratio 13.068, 95% confidence interval 2.425-70.434, p=0.003). CIN was mostly associated with baseline creatinine level rather than CM amount using nonionic isosmolar CM. We found that patients with CIN had worse event-free survival than patients without CIN after multifactorial adjustment.

Contrast-Induced Nephropathy in Patients Undergoing Emergency Percutaneous Coronary Intervention for Acute Coronary Syndrome

Contrast-induced nephropathy (CIN) is associated with significantly increased morbidity and mortality after coronary angiography and percutaneous coronary intervention (PCI). The aim of the present study was to assess the clinical features and in-hospital outcomes of CIN after emergency PCI. The serum creatinine (SCr) concentration was measured from days 0 to 30 in 338 consecutive patients with acute coronary syndrome undergoing emergency PCI. CIN was defined as an increase in SCr of >25% or >0.5 mg/dl within 2 days after PCI. Overall, 94 patients (28%) developed CIN. The mean SCr on admission was not significantly different between patients with CIN and those without CIN. The CIN group had significantly greater SCr at days 1, 2, and 30 than did the no CIN group. Multivariate analysis showed female gender (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.12 to 5.07, p = 0.025), a culprit lesion in the left anterior descending artery (OR 2.37, 95% CI 1.31 to 4.27, p = 0.0042), contrast agent volume >200 ml (OR 3.60, 95% CI 1.96 to 6.62, p <0.001) and end-diastolic pulmonary arterial pressure >15 mm Hg (OR 2.03, 95% CI 1.02 to 4.04, p <0.01) to all correlate independently with CIN. The in-hospital mortality rate was greater in the CIN group than in the no CIN group (9.6% vs 3.3%, respectively; p = 0.025). In conclusion, CIN is a frequent complication of emergency PCI for acute coronary syndrome and is associated with a greater mortality rate and persistent renal dysfunction.

Incidence and Outcomes of Contrast-Induced Nephropathy After Computed Tomography in Patients With CKD: A Quality Improvement Report

Although there has been considerable investigation of the general characteristics of contrast-induced nephropathy (CIN), it has not been studied adequately in a computed tomography (CT) population. We assessed the incidence and outcomes of CIN after contrast-enhanced CT in patients with chronic kidney disease pretreated with saline and N-acetylcysteine (NAC). Quality improvement report. 520 patients registered in a CIN prevention program. We initiated the CIN prevention program in January 2007. In this program, patients with chronic kidney disease undergoing contrast-enhanced CT in an outpatient setting were automatically referred to nephrologists, and patients received saline and NAC before and after CT. The development of CIN was assessed 48-96 hours after CT. Incidence of CIN and time to renal replacement therapy. Baseline serum creatinine, hemoglobin, and serum albumin levels; type and volume of contrast agents; and post-CT serum creatinine level. Overall, CIN occurred in 13 (2.5%) patients. Incidences of CIN were 0.0%, 2.9%, and 12.1% in patients with an estimated glomerular filtration rate of 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively. The risk of CIN was increased in patients with severely decreased kidney function and diabetes. The development of CIN consequently increased the risk of renal replacement therapy (P < 0.001 by log-rank), and the risk was significantly accentuated in patients with estimated glomerular filtration rate <30 mL/min/1.73 m(2). A single-center study and comparison with previous studies. The incidence of CIN was relatively low in patients treated with saline and NAC. The development of CIN predisposed to poor kidney survival in the long term.

Contrast-Induced Nephropathy in Postmenopausal Women Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction

Contrast-induced nephropathy (CIN) is a complex syndrome of acute kidney injury induced by exposure to intravascular contrast media. CIN occurs frequently in patients undergoing urgent percutaneous coronary intervention (PCI) and is associated with poor outcomes, making it a major challenge faced by interventional cardiologists. It has been suggested that female sex is a risk factor for development of CIN following PCI. However, no data exist in the literature concerning the risks of postmenopausal women with acute myocardial infarction (AMI) developing CIN after undergoing urgent PCI. To explore the incidence, risk factors and in-hospital outcomes of CIN in this special population, we analyzed 69 postmenopausal women with AMI treated with urgent PCI. CIN was defined as a relative increase of >25% or an absolute increase of >or=0.5 mg/dL in serum creatinine concentration from the baseline value 72 h after exposure to contrast medium. We found 1) the incidence of CIN was 37.68%; 2) patients with CIN had worse in-hospital outcomes, including longer hospital stay and more in-hospital adverse events; and 3) in multivariate logistic analysis, independent risk factors for CIN included a longer menopausal duration and the implantation of an intra-aortic balloon pump (an indirect indicator of hemodynamic instability). These results indicate that CIN is a frequent complication associated with worse in-hospital outcomes in postmenopausal women with AMI who are undergoing urgent PCI, particularly those with longer menopausal duration and hemodynamic instability. It is therefore necessary to pay more attention to preventive strategies for renal protection in this special population.

Systematic Review: Sodium Bicarbonate Treatment Regimens for the Prevention of Contrast-Induced Nephropathy

Intravenous sodium bicarbonate has been proposed to reduce the risk for contrast-induced nephropathy (CIN). To determine the effect of sodium bicarbonate on the risk for CIN. MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from 1950 to December 2008; conference proceedings; and ClinicalTrials.gov, without language restriction. Randomized, controlled trials of intravenous sodium bicarbonate that prespecified the outcome of CIN as a 25% increase in baseline serum creatinine level or an absolute increase of 44 micromol/L (0.5 mg/dL) after radiocontrast administration. Using standardized protocols, 2 reviewers serially abstracted data for each study. 23 published and unpublished trials with information on 3563 patients and 396 CIN events were included. The pooled relative risk was 0.62 (95% CI, 0.45 to 0.86), with evidence of significant heterogeneity across studies (I(2) = 49.1%; P = 0.004). Some heterogeneity was due to the difference in the estimates between published and unpublished studies: relative risk, 0.43 (CI, 0.25 to 0.75) versus 0.78 (CI, 0.52 to 1.17), respectively. Meta-regression showed that small, poor-quality studies that assessed outcomes soon after radiocontrast administration were more likely to suggest benefit (P < 0.05 for all). No clear effects of treatment on the risk for dialysis, heart failure, and total mortality were identified. Power to assess clinical end points was limited. The effectiveness of sodium bicarbonate treatment to prevent CIN in high-risk patients remains uncertain. Earlier reports probably overestimated the magnitude of any benefit, whereas larger, more recent trials have had neutral results. Large multicenter trials are required to clarify whether sodium bicarbonate has value for prevention of CIN before routine use can be recommended. None.