Overall Incidence Of Contrast-induced Nephropathy Research Articles

Predictive value of hemoglobin-to-red blood cell distribution width ratio for contrast-induced nephropathy after emergency percutaneous coronary intervention.

Although the relationship of either hemoglobin or red blood cell distribution width (RDW) with contrast-induced nephropathy (CIN) has been reported individually. To date, no studies have evaluated the predictive value of hemoglobin-to-red blood cell distribution width ratio (HRR) for CIN. A total of 1658 elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) were retrospectively screened. Preoperative complete blood count was collected and the HRR was calculated as the ratio of hemoglobin to RDW. CIN was defined as an absolute ≥0.5mg/dL (44.2μmol/L) or a relative ≥25% increase in creatinine level at 72h after contrast administration. Univariate and multivariate regression analysis were conducted to determine the effective predictors for CIN. The ROC curve analysis was plotted to determine the optimal cutoff value for HRR in predicting CIN. The overall incidence of CIN was 8.38%. The HRR was significantly lower in the CIN group compared with the non-CIN group (0.87 ± 0.15 vs 1.24 ± 0.23, p < 0.001). After multivariate regression analysis was performed, HRR was noted to be an effective predictor for the development of CIN (OR 1.617, 95% CI 1.439-2.706, p = 0.014), along with age, creatinine, eGFR, hs-CRP and contrast volume. An optimal cutoff value of 0.94 or lower for HRR was identified with 82.4% sensitivity and 63.5% specificity to predict CIN. Lower HRR on admission was an effective predictor for CIN in elderly patients with STEMI undergoing emergency PCI. HRR may be a convenient, economical and reliable biomarker for risk stratification.

Risk factor profile, incidence, and relevance of Mehran risk score to predict contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Background: Contrast-induced nephropathy (CIN) is a grave but underdiagnosed complication of percutaneous coronary intervention (PCI) that is associated with increased in-hospital morbidity and mortality. Our aim was to study the incidence, risk factors of CIN, and applicability of Mehran risk score (MRS) in Indian population. Materials and Methods: A total number of 432 patients were enrolled in the study. Inclusion criteria were patients with acute coronary syndrome or chronic stable angina who underwent PCI. Baseline parameters of patients were noted and patients were followed for development of CIN. Results: The mean age of the study population was 57.2 + 10.43 years; males were 348 (80.6%) and females 84 (19.4%). Hypertension was present in 257 patients (59.5%), diabetes in 208 (48.1%), smoking in 208 (48.1%), anemia in 104 (24.1%), and heart failure in 95 (22%); the mean estimated glomerular filtration rate (eGFR) was 88.4 + 30.65 ml/min/1.73 m2 and the mean contrast volume usage was 122.8 + 41.9 ml. 64 patients (14.8%) developed CIN. On univariate analysis, age (P = 0.435), gender (0.125), hypertension (0.679), diabetes (0.177), and contrast volume (0.155) were not associated with the development of CIN, whereas smoking (0.021), hypotension (&lt;0.001), heart failure (&lt;0.001), anemia (0.001), and median eGFR (P &lt; 0.001) were significantly associated with the development of CIN. However, on multivariate regression analysis, smoking was not associated with the development of CIN (P = 0.104). The incidence of CIN was 2.7-fold higher (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.299–5.540, P= 0.008) in the intermediate group (MRS 6-10), 5.4-fold higher (OR: 5.403, 95% CI: 2.249–12.978, P &lt; 0.001) in the high-risk group (MRS 11–15), and 51-fold higher (OR: 51.059, 95% CI: 18.195–143.278,P&lt; 0.001) in the very high-risk groups (MRS &gt;16) when compared to the low-risk group (MRS &lt; 5). Dialysis was required only in 2 (3.1%) patients (P &lt; 0.022). Conclusions: The overall incidence of CIN was 14.8%. The incidence of CIN in the very high-risk group (MRS &gt;16) was substantially higher in our study (77.8%) as compared to the same group in Mehran study (57.3%).

Meta-analysis of effect of renin-angiotensin-aldosterone system blockers on contrast-induced nephropathy.

Background:The purpose of this study was to systematically evaluate the effect of renin–angiotensin–aldosterone system blockers on the incidence of contrast-induced nephropathy in patients undergoing coronary angiography or percutaneous coronary intervention.Methods:A systematic literature search of several databases was conducted to identify studies that met the inclusion criteria. A total of 12 studies with 14 trials that performed studies on a total of 4864 patients (2484 treated with renin–angiotensin–aldosterone system blockers and 2380 in the control group) were included. The primary endpoint was the overall incidence of contrast-induced nephropathy. Analyses were performed with STATA version 12.0.Results:The overall contrast-induced nephropathy incidence in renin–angiotensin–aldosterone system blocker and control groups was 10.43% and 6.81%, respectively. The pooled relative risk of contrast-induced nephropathy incidence was 1.22 (95% confidence interval: 0.81–1.84) in the renin–angiotensin–aldosterone system blocker group. An increased risk of developing contrast-induced nephropathy in the renin–angiotensin–aldosterone system blocker group was observed among older people, non-Asians, chronic users, and studies with larger sample size, and the pooled RRs and 95% confidence intervals were 2.02 (1.21–3.36), 2.30 (1.41–3.76), 1.69 (1.10–2.59) and 1.83 (1.28–2.63), respectively.Conclusions:Intervention with renin–angiotensin–aldosterone system blockers was associated with an increased risk of contrast-induced nephropathy among non-Asians, chronic users, older people, and studies with larger sample size. Large clinical trials with strict inclusion criteria are needed to confirm our results and to evaluate the effect further.

Persistent Renal Dysfunction in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction.

BackgroundThe long‐term prognosis of patients with acute myocardial infarction who develop persistent renal dysfunction (RD) remains unclear. We investigated risk factors and prognostic implications of persistent RD after contrast‐induced nephropathy (CIN) in patients with acute myocardial infarction after primary percutaneous coronary intervention.Methods and ResultsWe enrolled 952 consecutive patients who underwent primary percutaneous coronary intervention for acute myocardial infarction. CIN was defined as an increase in serum creatinine levels ≥0.5 mg/dL or ≥25% from baseline within 72 hours after percutaneous coronary intervention. Persistent RD was defined as residual impairment of renal function over 2 weeks, and transient RD was defined as recovery of renal function within 2 weeks, after CIN. The overall incidence of CIN was 8.8% and that of persistent CIN was 3.1%. A receiver‐operator characteristic curve showed that the optimal cutoff value of the contrast volume/baseline estimated glomerular filtration rate ratio for persistent CIN was 3.45. In multivariable logistic analysis, a contrast volume/baseline estimated glomerular filtration rate >3.45 was an independent correlate of persistent RD. At 3 years, the incidence of death was significantly higher in patients with persistent RD than in those with transient RD (P=0.001) and in those without CIN (P<0.001). Cox regression analysis showed that persistent RD (hazard ratio, 4.99; 95% CI, 2.30–10.8; P<0.001) was a significant risk factor for mortality. A similar trend was observed for the combined end points, which included mortality, hemodialysis, stroke, and acute myocardial infarction.ConclusionsPersistent RD, but not transient RD, is independently associated with long‐term mortality. A contrast volume/baseline estimated glomerular filtration rate >3.45 is an independent predictor of persistent RD.

Prevalence and Predictors of Contrast-Induced Nephropathy (CIN) in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Percutaneous Coronary Intervention (PCI): A Meta-Analysis.

Background Contrast-induced nephropathy (CIN) becomes more and more frequent after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). There have been no reported meta-analyses to determine the role of these risk factors in predicting CIN in patients with STEMI undergoing PCI. So we made this meta-analysis to summarize the incidence of CIN in patients with STEMI undergoing PCI and to study associations between CIN and several risk factors that are mentioned in most prevention guidelines. Hypothesis The overall incidence of CIN in patients with STEMI undergoing PCI is not low. Many risk factors could influence the occurrence of CIN, such as hypertension, diabetes mellitus (DM), and lower estimated glomerular filtration rate. Methods Databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical (CBM), were searched for articles published before May 21, 2019, to identify all relevant studies on CIN. The pooled data were analyzed using either fixed-effects or random-effects models depending on heterogeneity (assessed via the I2 index). Results Twelve articles encompassing a total of 6342 patients were included. The overall pooled CIN incidence was 13.3% (95% CI: 10.4–17.1). The forest plots showed positive associations between CIN and the presence of hypertension, diabetes mellitus, history of prior myocardial infarction, age, damaged left anterior descending artery, Killip class ≥2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction <40%; the odds ratios for these factors were 1.85 (95% CI: 1.57–2.18; p < 0.00001), 1.83 (95% CI: 1.47–2.29; p < 0.00001), 2.14 (95% CI: 1.46–3.14; p < 0.0001), 7.79 (95% CI: 5.24–10.34; p < 0.00001), 1.92 (95% CI: 1.15–3.22; p=0.01), 3.12 (95% CI: 2.21–4.40; p < 0.00001), −6.15 (95% CI: −9.52 to −2.79; p=0.0003), −15.06 (95% CI: −24.75 to −5.36; p=0.002), and 5.53 (95% CI: 1.10–27.95; p=0.04), respectively. Conclusion The overall incidence of CIN in patients with STEMI undergoing PCI was not low and was closely associated with hypertension, diabetes mellitus, history of prior myocardial infarction, age, damaged left anterior descending artery, Killip class ≥2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction <40%.

Contrast-Induced Nephropathy After Peripheral Vascular Interventions in Kidney Transplant Recipients

Contrast-induced nephropathy (CIN) is a dreaded complication of peripheral vascular interventions (PVIs), especially for kidney transplant recipients (KTRs). However, the incidence of and factors associated with CIN in that population of patients have not been studied. The Vascular Quality Initiative PVI data set from 2010 to 2018 was reviewed. Only KTRs treated for peripheral artery disease were included. Patients were stratified on the basis of chronic kidney disease (CKD) stages into KTRs with a graft with good function (GGF; CKD1-2, estimated glomerular filtration rate ≥60 mL/min/1.73 m2) and KTRs with a graft with poor function (GPF; CKD3-5, estimated glomerular filtration rate <60 mL/min/1.73 m2). Patients' characteristics and outcomes were compared between the two groups. Risk factors for CIN in KTRs were identified by multivariable regression. Overall, only 1.02% (n = 1633/160,047) of PVIs were performed in KTRs. Interventions were evenly distributed between the two groups (GGF, 51% [n = 342]; GPF, 49% [n = 325]). Most cases were performed electively (77% [n = 515]) on an inpatient basis (53% [n = 354]). KTRs with GPF were older (64.8 vs 62.5 years; P < .01) and more likely to be female (33% vs 26%; P = .04). Patients with GPF also were more likely to have baseline congestive heart failure (12% vs 5%; P < .01), hypertension (96% vs 91%; P = .01), and implanted pacemakers (7.1% vs 2.3%; P < .01). Contrast material volume used was significantly lower in KTRs with GPF (50.7 mL vs 60.6 mL; P < .01), but there was no other difference in procedural characteristics. The overall incidence of CIN was 3%, and it was significantly higher in GPF compared with GGF (4.6% vs 1.5%; P = .02). There were no other differences in outcomes (Table). Multivariable logistic regression demonstrated that GPF compared with GGF (odds ratio, 4.37; confidence interval, 1.21-15.8) and anticoagulant use (odds ratio, 4.85; confidence interval, 1.78-13.2) were independently associated with CIN. In this model, contrast material volume was not significantly associated with CIN (P = .19). KTRs constitute a small fraction of patients undergoing PVIs. PVIs in KTRs are associated with a significant risk of nephropathy that is elevated with poor baseline graft function and preoperative use of anticoagulants.TableCharacteristics of kidney transplant recipients (KTRs) undergoing peripheral vascular interventionsGGF, CKD1-2 (51% [n = 341])GPF, CKD3-5 (49% [n = 325])PDemographics Age, years62.47 (10.23)64.74 (8.99)<.01 BMI, kg/m227.72 (6.06)27.96 (5.72).6 Female26 (88)33 (108).04 White66 (226)65 (209).59 Inpatient53 (180)53 (173).91 Elective surgery75 (256)79 (257).22 Ambulatory90 (303)90 (287).82 Smoker14 (48)12 (38).36Comorbidities/medications CHF5 (17)12 (39)<.01 Diabetes77 (264)82 (266).16 Hypertension91 (310)96 (311).01 COPD10 (34)15 (48).06 Atrial fibrillation13 (46)15 (49).56 Implanted pacemaker2.3 (8)7.1 (23)<.01 CAD36 (123)37 (121).76 CVD17 (58)16 (51).65 Preoperative ACE-I/ARB37 (125)32 (104).21 Preoperative ASA class78 (266)73 (238).15 Preoperative anticoagulation19 (65)20 (65).76 Preoperative antiplatelets36 (121)37 (120).7 Preoperative statin73 (249)77 (251).21Procedural characteristics Fluoroscopy time, minutes18.65 (15.86)19.20 (14.36).65 Contrast material volume, mL60.68 (44.22)50.71 (39.22)<.01 No. of arteries treated1.64 (0.81)1.67 (0.82).59Indications Asymptomatic PAD2.6 (9)4.6 (15).17 Claudication25 (86)22 (70).26 Rest pain8.2 (28)4.6 (15).06 Tissue loss60 (203)65 (212).13 Acute limb ischemia4.4 (15)4 (13).8Perioperative outcomes CIN1.5 (5)4.6 (15).02 Cardiac complication1.2 (4)3.4 (11).07 Postoperative MI1.2 (4)2.2 (7).37 Pulmonary complication0.88 (3)1.8 (6).33 Access site complication0.29 (1)0.62 (2).62 Major amputation at 30 days2.3 (3)2.3 (2)1.00 Mortality at 30 days0.68 (1)1.41 (2).62Long-term outcomes Major amputation at 1 year5.3 (7)11.6 (10).12 Mortality at 1 year9.3 (7)11.1 (5).76ACE-I, Angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ASA, American Society of Anesthesiologists; BMI, body mass index; CAD, coronary artery disease; CHF, congestive heart failure; CIN, contrast-induced nephropathy; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CVD, chronic venous disease; GGF, graft with good function; GPF, graft with poor function; MI, myocardial infarction; PAD, peripheral artery disease.Categorical variables are presented as percentage (number). Continuous variables are presented as mean (standard deviation). Boldface values indicate statistical significance. Open table in a new tab

A simple risk score model for predicting contrast-induced nephropathy after coronary angiography in patients with diabetes.

Contrast-induced nephropathy (CIN) is a common complication in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) and associated with poor outcome. Some previous studies have already set up models to predict CIN, but there is no model for patients with diabetes mellitus (DM) especially. Therefore, we aim to develop and validate a simple risk score for predicting the risk of CIN in patients with DM undergoing CAG/PCI. A total of 1157 consecutive patients with DM undergoing CAG/PCI were randomly assigned to a development cohort (n = 771) and a validation cohort (n = 386). The primary endpoint was CIN, which was defined as an absolute increase in serum creatinine (SCr) by 0.5mg/dL from the baseline within 48-72h after contrast exposure. The independent predictors for CIN were identified by multivariate logistic regression, and the discrimination and calibration of the risk score were assessed by ROC curve and Hosmer-Lemeshow test, respectively. The overall incidence of CIN was 45 (3.9%). The new simple risk score (Chen score), which included four independent variables (age > 75years, acute myocardial infarction, SCr > 1.5mg/dL, the use of intra-aortic balloon pump), exhibited a similar discrimination and predictive ability on CIN (AUC 0.813, 0.843, 0.796, P > 0.05, respectively), mortality (AUC 0.735, 0.771, 0.826, respectively) and MACEs when being compared with the classical Mehran or ACEF risk score. Our data suggest that the new simple risk score might be a good tool for predicting CIN in patients with DM undergoing CAG/PCI.

A novel risk score model for prediction of contrast-induced nephropathy after emergent percutaneous coronary intervention

BackgroundA few studies developed simple risk model for predicting CIN with poor prognosis after emergent PCI. The study aimed to develop and validate a novel tool for predicting the risk of contrast-induced nephropathy (CIN) in patients undergoing emergent percutaneous coronary intervention (PCI). Methods692 consecutive patients undergoing emergent PCI between January 2010 and December 2013 were randomly (2:1) assigned to a development dataset (n=461) and a validation dataset (n=231). Multivariate logistic regression was applied to identify independent predictors of CIN, and established CIN predicting model, whose prognostic accuracy was assessed using the c-statistic for discrimination and the Hosmere Lemeshow test for calibration. ResultsThe overall incidence of CIN was 55(7.9%). A total of 11 variables were analyzed, including age >75years old, baseline serum creatinine (SCr)>1.5mg/dl, hypotension and the use of intra-aortic balloon pump(IABP), which were identified to enter risk score model (Chen). The incidence of CIN was 32(6.9%) in the development dataset (in low risk (score=0), 1.0%, moderate risk (score:1–2), 13.4%, high risk (score≥3), 90.0%). Compared to the classical Mehran's and ACEF CIN risk score models, the risk score (Chen) across the subgroup of the study population exhibited similar discrimination and predictive ability on CIN (c-statistic:0.828, 0.776, 0.853, respectively), in-hospital mortality, 2, 3-years mortality (c-statistic:0.738.0.750, 0.845, respectively) in the validation population. ConclusionsOur data showed that this simple risk model exhibited good discrimination and predictive ability on CIN, similar to Mehran's and ACEF score, and even on long-term mortality after emergent PCI.

Incidence of contrast-induced nephropathy a prospective study

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

Preprocedural High-Sensitivity C-Reactive Protein Predicts Contrast-Induced Nephropathy and Long-Term Outcome After Coronary Angiography.

We investigated whether high-sensitivity C-reactive protein (hsCRP) levels were associated with contrast-induced nephropathy (CIN) and long-term mortality after coronary angiography (CAG). Patients (N = 2133) undergoing CAG with preprocedural hsCRP were consecutively enrolled. High-sensitivity C-reactive protein was measured before angiography. Median follow-up was 2.3 years. The overall incidence of CIN was 2.77% (59 of 2133). There was a positive trend of hsCRP quartiles (Q) with rates of CIN: 0.9% for Q1 (<1.6 mg/L), 0.9% for Q2 (1.6-3.9 mg/L), 2.4% for Q3 (4.0-11.3mg/L), and 6.8% for Q4 (>11.3 mg/L; P < .05). The receiver operating characteristic (ROC) analysis showed that the cutoff point of hsCRP was 7.3 mg/L for predicting CIN with a 72.7% sensitivity and a 67.0% specificity (area under the curve [AUC] = 0.742, 95% confidence interval [CI] 0.672-0.810; P < .05). The predictive value of hsCRP was similar to the Mehran score for CIN (AUChsCRP = 0.742 vs AUCMehran = 0.801; P = .228). After adjustment for other potential risk factors, hsCRP >7.3 mg/L still was an independent predictor of CIN (odds ratio [OR] = 2.83, 95% CI: 1.44-5.58; P = .003). Furthermore, hsCRP >7.3 mg/L was associated with higher mortality (OR = 2.04, 95% CI: 1.30-3.19; P = .002).

Incidence of Contrast-Induced Nephropathy After Renal Graft Catheter Arteriography Using Iodine-Based Contrast Medium.

The objective of our study was to assess the incidence of contrast-induced nephropathy (CIN), dialysis, and graft loss after direct intraarterial infusion of iodine-based contrast medium (CM) in renal allograft recipients. One hundred patients underwent renal graft catheter arteriography between 2006 and 2014. CIN was defined as an increase in serum creatinine value of 0.5 mg/dL or more above the creatinine value before arteriography. CIN could be assessed in 37 patients with creatinine levels obtained before arteriography and 24-72 hours after arteriography. Dialysis requirement and renal allograft loss at 30 days after the procedure were recorded in all 100 patients. In the 37 patients who could be assessed for CIN, three patients (8%) met the criteria for CIN. In a subgroup analysis, there was an increased incidence of CIN in patients undergoing angiography alone (25%) compared with those in the angioplasty and stenting group (0%) (p = 0.028). At 30 days after the procedure, none (0/100) of the patients required dialysis or had graft failure. In a cohort of patients with a single renal allograft undergoing renal graft catheter arteriography using iodine-based CM, the overall incidence of CIN was low and no major adverse outcomes were noted at 30 days after the procedure. However, in a subgroup analysis, the patients who underwent arteriography alone-that is, without angioplasty or stenting-had a statistically significant higher rate of CIN.

Preventive effect of reduced glutathione on contrast-induced nephropathy in elderly patients undergoing coronary angiography or intervention: a randomized, controlled trial.

Coronary angiography can be a high-risk condition for the incidence of contrast-induced nephropathy (CIN) in elderly patients. Reduced glutathione, under a variety of mechanisms, may prevent CIN in this procedure. We prospectively examined whether hydration with reduced glutathione is superior to hydration alone for prevention of CIN in an elderly Han Chinese population. A total of 505 patients (271 males and 234 females) aged 75 years or older who underwent non-emergency coronary angiography or an intervention were randomly divided into two groups. The treatment group received hydration with reduced glutathione (n=262) and the control group received hydration alone (n=243). Serum creatinine and blood urea nitrogen levels were measured prior to coronary angiography and 48 h after this procedure. The primary endpoint was occurrence of CIN, which was defined as 25% or 44.2 µmol/L above baseline serum creatinine levels 48 h after the procedure. The overall incidence of CIN was 6.49% in the treatment group and 7.41% in the control group, with no significant difference between the groups (P=0.68). In subgroup analysis by percutaneous coronary intervention, no significant differences were found between the two groups. In summary, reduced glutathione added to optimal hydration does not further decrease the risk of CIN in elderly patients undergoing coronary angiography or an intervention.

Follow up for emergency department patients after intravenous contrast and risk of nephropathy.

Introduction: Contrast-induced nephropathy (CIN), defined as an increase in serum creatinine (SCr) greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV) contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED) and were discharged home after computed tomography (CT) of the abdomen and pelvis (AP) with IV contrast.Methods: We conducted a single center retrospective review of charts for patients who required CT of AP with IV contrast and who were discharged home. Patients' clinical data included the presence of diabetes mellitus, hypertension, chronic kidney disease (CKD) and congestive heart failure (CHF).Results: Five hundred and thirty six patients underwent CT of AP with IV contrast in 2011 and were discharged home. Diabetes mellitus was documented in 96 patients (18%). Hypertension was present in 141 patients (26.3%), and 82 patients (15.3%) were on angiotensin-converting-enzyme inhibitors (ACEI). Five patients (0.9%) had documented CHF and all of them were taking furosemide. Seventy patients (13%) had a baseline SCr >1.2 mg/dL. One hundred fifty patients (28%) followed up in one of the clinics or the ED within one week after discharge, but only 40 patients (7.5%) had laboratory workup. Out of 40 patients who followed up within 1 week after discharge, 9 patients (22.5%) developed CIN. One hundred ninety patients (35.4%) followed up in one of the clinics or the ED after 7 days and within 1 month after discharge, but only 71 patients (13.2%) had laboratory workup completed. Out of 71 patients who followed up within 1 month, 11 patients (15%) developed CIN. The overall incidence of CIN was 15.3% (17 out of 111 patients).Conclusion: There was a poor outpatient follow up after CT of AP with IV contrast and biochemically CIN appears to be present in some patients. Unlike previous reports that CKD is the major risk factor for CIN, our results demonstrated that risk factors such as advanced age, DM and hypertension seem to predispose patients to CIN rather than abnormal baseline SCr. [West J Emerg Med. 2014;15(3):276–281.]

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.

Risk factors for acute kidney injury in the elderly undergoing contrast-enhanced computed tomography in the emergency department

BackgroundThere have been few studies focusing on the incidence and risk factors for elderly patients undergoing computed tomography (CT) scans with intravascular contrast medium, who develop contrast-induced nephropathy (CIN) in the emergency department (ED). Our objective was to investigate the incidence of and risk factors for, CIN in elderly patients seen in the ED, who receive intravenous contrast media for CT examination. MethodsPatients ≥65 years of age who received contrast-enhanced CT were eligible for inclusion in this retrospective analysis. CIN was defined as an increase in serum creatinine (sCr) ≥0.5 mg/dL 48 to 72 hours after intravenous contrast administration. Multiple logistic regression analysis for risk factors for CIN and Chi-square test were performed for trend analysis for CIN incidence and mortality of different risk scores. ResultsA total of 594 patients, with a mean age of 79.8 ± 6.8 years were included. The overall incidence of CIN was 8.6%. In multivariate analyses, CIN was associated with diabetes mellitus [adjusted odds ratio (OR) = 1.93; 95% confidence interval (CI) = 1.04–3.62], precontrast sCr >1.5 mg/dL (OR = 2.72; 95% CI = 1.44–5.13), and acute hypotension (OR = 3.56; 95% CI = 1.29–9.84). CIN and mortality increased with increasing risk score (p < 0.001 and p = 0.001, respectively). The all-cause in-hospital mortality rate was 13.1%, and the mortality rates for patients with and without CIN (p < 0.001) were 47.1% and 9.9%, respectively. ConclusionOur investigation confirmed diabetes mellitus, precontrast sCr >1.5 mg/dL and acute hypotension as risk factors for CIN, and also developed a simple risk score for elderly patients seen in the ED.

RISK SCORE FOR PREDICTION OF CONTRAST INDUCED NEPHROPATHY IN HAN CHINESE UNDERWENT PERCUTANEOUS CORONARY INTERVENTION

ObjectivesTo develop a simplified risk score of contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for Han Chinese.MethodsA retrospective study was performed on 1500 patients for the development dataset,...

Contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

To evaluate the safety of contrast-enhanced MDCT in patients with renal impairment. We conducted a retrospective review of 938 patients with stable renal insufficiency (eGFR between 15 and 60ml/min) who underwent contrast-enhanced MDCT. SCr levels were measured at baseline and 48-72h after contrast medium administration. The incidence of contrast-induced nephropathy (CIN) in the total study population was assessed. As a control group, 1,164 separate patients with renal insufficiency who did not receive contrast medium for CT were also reviewed. The overall incidence of CIN in the patient population with renal insufficiency was 6.1%; the incidence was 4.4%, 10.5% and 10.0% for patients whose eGFR was 45-60, 30-45 and ≤30ml/min, respectively (P < 0.01). In the control group, 5.8% of patients showed an increase in the SCr level from the baseline. The increase in the SCr level showed no significant difference between the patients who received CM and those who did not (P = 0.82) CONCLUSIONS: The risk of CIN from contrast-enhanced MDCT in patients with renal insufficiency appeared to be low, and there was no significant difference in the incidence of CIN in comparison with patients who did not receive CM. • The contrast medium used for multidetector CT can induce nephropathy. • Contrast-induced nephropathy (CIN) developed in 6.1% of patients with renal insufficiency. • However, nephropathy developed in 5.8% of similar patients not receiving contrast medium. • Thus, the risk of CIN associated with MDCT appears to be low. • Special care should still be taken in patients with renal insufficiency.

English

N-Acetylcysteine (NAC) is used in the prevention of contrast-induced nephropathy (CIN) in our institution. The variation in clinical effects as a result of dosage differences between intravenous (IV) and oral administration warrants further investigation. This study primarily aimed to evaluate the incidence of CIN in patients with renal impairment, comparing those who received IV NAC with those receiving oral NAC. This was an observational, retrospective study conducted from 1st January, 2007 to 31st March, 2010. The study included 94 renally impaired patients (baseline glomerular filtration rate (eGFR) < 70 ml/min/1.73 m 2 ) who had undergone iodinated-contrast procedure, and received either IV NAC (150 mg/kg pre-procedure, then 50 mg/kg post-procedure) or oral NAC (600 mg twice daily for one day before the procedure, then for two days after the procedure). The changes in serum creatinine (SCr) over time: pre-procedure, post-procedure 24, 48 and 72 h for both regimens were recorded and analysed. The overall incidence of CIN was 22% in IV NAC group versus 28.0% in the oral group (P = 0.403). CIN was found to be significantly associated with unstable renal function but not route of NAC administration. In patients with stable renal function, the incidence of CIN was 8.3% in the IV group versus 11.9% in the oral group; P = 1.000. In patients with unstable renal function, the incidence of CIN was 46.2 and 42.9% in the IV and oral groups, respectively; P = 0.863. Diabetes mellitus (odds ratio (OR) = 10.704, P = 0.018) and unstable renal status (OR = 6.800, P = 0.015) were the independent predictors of CIN by multivariate analysis. Both IV and oral NAC had comparable effects on the incidence of CIN in patients with stable renal status. However, both routes of NAC administration were less effective in preventing CIN in patients with unstable renal status.

Risk score for prediction of contrast induce nephropathy in patients underwent percutaneous coronary intervention

ObjectiveTo develop a simplified risk score of contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI).MethodsA retrospective study was performed on 1500 patients for the development dataset, who had undergone...

Effects of Microbial Populations on Anthocyanin Profile of Sangiovese Wines Produced in Tuscany, Italy

<h3>Objectives</h3> To develop a simplified risk score of contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for Han Chinese. <h3>Methods</h3> A retrospective study was performed on 1500 patients for the development dataset, who had undergone PCI from January 2008 to May 2010. And one thousand patients treated in the same period were selected for the validation set. Logistic regression analysis was applied to identify risk factors for CIN. Based on the OR, the sum of the integers was a total risk score for each patient. <h3>Results</h3> (1) Among the 1500 patients, CIN occurred in 246 patients and the overall incidence of CIN was 16.4%. (2) Eleven identified variables were identified as risk factors for CIN (with weighted integer): diabetes (3 score), hypotension (3 score), Left ventricular ejection fraction (LVEF≤45%) (3 score), eGFR &lt;60 ml/min/1.73 m² (3 score), age&gt;70 years (2 score), myocardial infarction (2 score), emergency PCI (2 score), anaemia (2 score), decreased high-density lipoprotein (HDL) concentration (&lt;1 mmol/l) (2 score), contrast agent dose of &gt;200 ml (2 score), low permeability contrast agent (1 score). (3) The sum of the integers was a total risk score for each patient. The incidence of CIN was 5.2% in low risk group (≤4), 13.6% in the moderate risk group (5–10), 32.3% in the high risk group (11–14) and 59.0% in the very high risk group (≥15). (4) The model demonstrated good discriminative power in the validation population, showing that the increasing risk score was strongly associated with CIN (c-statistic=0.82). <h3>Conclusions</h3> This simple scoring system proposed here provides a good estimate of the risk of CIN after PCI for Han Chinese. This risk score can be used for the prevention and treatment of CIN.