Contrast-induced nephropathy associated factors in patients with significant coronary obstruction.
Main Article Content
Abstract
Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the “Hermanos Ameijeiras” hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p <0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication.
References
Arozarena, L. E., Pérez, M., & Torres, Y. (2015). Eficacia de la coronariografía en el adulto mayor. Revista de Ciencias Médicas de Pinar del Río, 19(3): 52-464. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-31942015000300009&lng=es&tlng=es.
Cheng, W., Wu, X., Liu, Q., Wang, H.S., Zhang, N.Y., Xiao, Y.Q., Yan, P., Li, X.W., Duan, X.J., Peng, J.C., Feng, S. & Duan, S.B. (2020) Post-contrast acute kidney injury in a hospitalized population: short-, mid-, and long-term outcome and risk factors for adverse events. European Radiology (2020) 30:3516–3527 https://doi.org/10.1007/s00330-020-06690-3
Connolly, M., Kinnin, M., Mc Eneaney, D., Menown, I., Kurth, M., Lamont, J., Morgan, N. & Harbinson, M. (2018). Prediction of contrast induced acute kidney injury using novel biomarkers following contrast coronary angiography. QJM: An International Journal of Medicine, 111(2):103-110, https://doi.org/10.1093/qjmed/hcx201
Ehrmann, S., Aronson, D. & Hinson, J.S. (2018). Contrast-associated acute kidney injury is a myth: Yes. Intensive Care Med 44: 104–106, https://doi.org/10.1007/s00134-017-4950-6
Ferreira Morales JL. (2017). Actualidad en nefropatía por medio de contraste. Nefrol Latinoam.; 14(2). Disponible en: https://ac.els-cdn.com/S2444903217300185/1-s2.0-S2444903217300185-main.pdf?_tid=9088df3a-f7aa-11e7-a567-00000aab0f26&acdnat=1515769948_36d16ceab6b9124fb286fba03b26ede4
Fuentes, S., Sanabria, M.A., Garnica, P., Espinosa, C., San Martin, C.R., Osorio N.W. (2019). Incidencia y factores de riesgo asociados con nefropatía inducida por medios de contraste en procedimientos intervencionistas de cardiología. Repertorio de Medicina y Cirugía, 28(3):171-177, DOI: 10.31260/RepertMedCir.v28.n3.2019.958
Graham, M. M., Ghali, W. A., Faris, P. D., Galbraith, P. D., Norris, C. M., Knudtson, M. L., & Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Investigators. (2002). Survival after coronary revascularization in the elderly. Circulation, 105(20): 2378–2384, https://doi.org/10.1161/01.cir.0000016640.99114.3d
Hernando, L., Canovas, E., Freites, A., de La Rosa, A., Alonso, J., del Castillo, R., Salinas, P., Montalvo, G.B., Huelmos, A.I. & Botas J. (2015). Prevalencia y pronóstico de la nefropatía tras intervencionismo coronario percutáneo de pacientes con síndrome coronario agudo y función renal normal. Rev Esp Cardiol, 68(4): 310–316, https://doi.org/10.1016/j.jacc.2004.07.043
Marenzi, G., Lauri, G., Assanelli, E., Campodonico, J., De Metrio M., Marana, I., Grazi, M., Veglia, F., & Bartorelli, A. L. (2004). Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction,
Journal of the American College of Cardiology, 44(9):1780-1785, https://doi.org/10.1016/j.jacc.2004.07.043
Mehran, R. & Nikolsky, E. (2006). Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl.; (100):S115. doi: 10.1038/sj.ki.5000368.
Mehran, R., Dangas, G.D. & Wiesbord S.D. (2019). Contrast-Associated Acute Kidney Injury N Engl J Med 2019;380: 2146-55. https://doi.org/10.1056/NEJMra1805256
Mueller, C., Buerkle, G., Buettner, H. J., Petersen, J., Perruchoud, A. P., Eriksson, U., Marsch, S. & Roskarmm, H. (2002). Prevention of contrast media-associated nephropathy randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med, 162: 329–36. DOI:10.1001/archinte.162.3.329
Poli, F., Gulsin, G.S., McCann, G. P., Burton, J. O., & Graham-Brown M. P. (2019). The assessment of coronary artery disease in patients with end-stage renal disease. Clinical Kidney Journal, 12(5):721-734, https://doi.org/10.1093/ckj/sfz088
Rear, R., Bell, R.M.& Hausenloy, D.J. (2016). Contrast- induced nephropathy following angiography and cardiac interventions. Heart, 0:1-11. http://dx.doi.org/10.1136/heartjnl-2014-306962
van der Molen, A.J., Reimer, P., Dekkers, I.A., Bongarts, G., Bellin, M.F., Bertolotto, M, Clement, O., Heinz-Peer, G., Stacul, F., Webb, J.A.W. & Thomsen, H. (2017). Post-contrast acute kidney injury – Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors European Radiology Received: 3 October 2017 /Revised: 22 November 2017 /Accepted: 5 December 2017 # The Author(s) 2018. https://doi.org/10.1007/s00330-017-5246-5
Weisbord, S.D., Gallagher, M., Jneid, H., Garcia, S., Cass, A., Thwin, S., Conner, T. A., Chertow, G.M., Bhatt, D.L., Shunk, K., Parikh, C.R., McFalls, E.O., Brophy, M., Ferguson, R., Wu, H., Androsenko, M., Myles, J., Kaufman, J. & Palevsky, P.M. for the PRESERVE Trial Group. (2018). Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. N Engl J Med, 378:603-614, DOI: 10.1056/NEJMoa1710933
World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053