Contrast induced nephropathy in patients of acute coronary syndrome with normal renal functions undergoing percutaneous coronary intervention
Keywords:Contrast induced nephropathy, percutaneous coronary intervention, complications of PCI.
Background: Contrast induced nephropathy is a well-known entity but it is less known that whether cardiac disease is a risk factor for this complication. Contrast induced nephropathy (CIN) is related with increase mortality and morbidity and the chances of this complication rises in patients who have coronary artery disease (CAD).
Objective: The objective of the study is to identify the frequency of contrast induced nephropathy in patients undergoing percutaneous coronary intervention who have normal baseline renal functions.
Material and methods: This cross sectional study conducted at angiography department of Punjab Institute of Cardiology, Lahore over a period of 2 years from January 2015 to January 2017. Patients regardless of gender with age of 30 - 65 years, diabetic or non-diabetics were included. Patients with renal disease or serum creatinine > 2 mg/dl at presentation or any other co-morbid medical illness, LV ejection fraction <30% were excluded from study. All the patients underwent coronary angioplasty. Renal function tests were checked 48 hours after procedure. The patients who had their creatinine level raised by 0.5mg/dl after 48hrs were labeled as sufferers of contrast induced nephropathy (CIN).
Results were compiled after studying the specific variables. Out of 5400 patients who underwent coronary angioplasty, 2988 (55.4%) patients were males & 2412 (44.6%) were females. Out of 5400 patients, 936 (17.33 %) suffered from CIN after PCI.
Patients suffered from CIN when following volume of contrast was used: <100ml, 36 (3.84%) patients, 100-200 ml, 288 (30.7%) patients and >200ml, 612 (65.3%) patients. According to the age group following patients suffered from CIN: 30-40 years, 72 (8.6%) patients, 41-55 years, 288 (11.2 %) patients and 56-65 years 576 (28.5%) patients. Out of 2988 male patients, 324 (10.8 %) patients suffered from CIN (p=0.06). Similarly, out of 2412 females 612 (25.3 %) patients had CIN (p=0.05). In 936 patients suffering from CIN, 684(73.1%) patients were diabetic and 252 (26.9%) were non-diabetic.
Conclusion: There is a high frequency of contrast induced nephropathy in elderly and diabetic patients who undergo PCI even if they have normal preexisting renal functions, so this complication can be avoided by the minimum use of contrast during the procedure
Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, et al. Heart disease and stroke statistics-2007 update: a report from the American Heart Association Statistics Committee and Stroke statistics subcommittee. Circulation 2007; 115:69-171.
Toprak O. Risk markers of Contrast induced nephropathy. Am J Med Sci 2007;334(4):283-90.
Katzberg RW, Haller C. Contrast-induced nephrotoxicity: clinical landscape. Kidney Int,2006;69:S3-S7.
Steinhubl SR, Charnigo R. Clopidogrel Treatment prior to percutaneous coronary interventions. JAMA.2006;295(13):1581-2.
Thom T, Haases N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T, et al. Heart disease and stroke statistics - 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006; 113:85– 151.
Harjai KJ, Raizada A, Shenoy C, Sattur S, Orshaw P, Boura J, et al. A Comparison of contemporary definitions of contrast nephropathy in patients undergoing percutaneous coronary intervention and a proposal for a novel nephropathy grading system. A J Cardiol, 2008;101(6):812–819.
Pannu N, Wiebe N, Toneli M. Prophylaxis strategies for contrast induced nephropathy. JAMA,2006;295(23):2765-79.
Shoukat S, Gowani AS, Jafferani A, Dhakam HS. Contrast induced nephropathy in Patients undergoing Percutaneous Coronary Intervention. Cardiol Res Pract,2010:649164.
Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int, 2006;(69): S11–S15.
Bennett MR, Ravipati N, Ross G, Nguyen MT Hirsch R, Rovner L, et al. Using proteomics to identify preprocedural risk factors for contrast induced nephropathy. PEOTEOMICS-proteomics clinical appl,2008;2(7-8):1058-64.
Goldenberg I, Matetzky S. Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ,2005;172(11):1461-71.
Wickenbrock I, Perings C, Maagh P, Quack I, van Bracht M, Prull MW, et al. Contrast medium induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome: differences in STEMI and NSTEMI. Clin Res Cardiol,2009;98(12):765-72
Lasser EC, Lyon SG, Berry CC. Reports on contrast media reactions: analysis of data from reports to the US Food and Drug Administration. Radiology 1997; 203: 605–10.
Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ ,et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002; 105(19):2259-64
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; 103:368-375 .
Keeley EC, Grines CL. Scraping of aortic debris by coronary guiding catheters: a prospective evaluation of 1,000 cases. J Am Coll Cardiol 1998; 32(5):1861-5
Rich MW, Crecelius CA. Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. A prospective study. Arch Intern Med 1990; 150: 1237–42.
Dangas G, Iakovou I, Nikolsky E, Aymong ED, Mintz GS, Kipshidze NN, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol.2005;95:13-19
Mehran R, Aymong ED, Nikolsky E, Fahy M, Lasic Z, Dangas G, 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: 1393–1399.
Nikolsky E, Mehran R, Turcot D Aymong ED, Mintz GS, Lasic Z, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol 2004; 94(3):300–5.
Berns AS. Nephrotoxicity of contrast media. Kidney Int 1989; 36: 730–740.
Parfrey PS, Griffiths SM, Barrett BJ, Paul MD, Genge M, Withers J, et al. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 1989; 320: 143–149.