Contrast-Induced Nephropathy in Interventional Cardiology: Incidence, Risk Factors, and Identification of High-Risk Patients

Abstract

Aim: This study aimed to study contrast-induced nephropathy (CIN) or more recent nomenclature contrast-associated acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary procedures, evaluating CIN incidence, risk factors (RFs), and high-risk patients with CIN. Methods: This is a prospective, observational, unicentric trial of patients who underwent coronary angiography and/or percutaneous coronary intervention (PCI) in the University Hospital Center (UHC) "Mother Teresa" in Tirana, Albania, during 2016-2018. CIN was defined as an increase of 25% and/or by 0.5 mg/dL of serum creatinine (SCr) and high-risk patients with CIN as an increase by 50% and/or by 2 mg/dL and/or need for dialysis compared to the basal pre-procedural values. We evaluated RFs for CIN: preexisting renal lesion (PRL), heart failure (HF), age, diabetes mellitus (DM), anemia, and contrast quantity. Results: The incidence of CIN resulted in 14.4%. HF, PRL, and age ≥65 years resulted in independent RFs for CIN, whereas anemia, DM, and contrast quantity >100 mL did not. PRL proved to be the most important RF for CIN, whereas HF was the only independent RF for high-risk CIN patients.

Conclusions: The incidence of CIN coincides with the results in the literature. PRL, HF, and age ≥65 years resulted in independent RFs for CIN; more and larger trials are needed to evaluate DM, anemia, and contrast quantity related to their impact on CIN. High-risk patients with CIN represent the most problematic patients of this pathology.

Keywords: contrast-induced nephropathy (cin); hydration; n-acetyl cysteine; preexisting renal lesion; risk factors.

Figure 1. Flowchart of the patients included in the study

Figure 2. ROC curve of the internal validity of our predictive value

The eGFR before the procedure (less than 60 ml/h) as a predictor of CIN in 48 hours showed an area under the curve of 74%, which was considered as a very good value (significant). Diagonal segments are produced by ties.

Figure 3. Relation between creatinine in 24 hours and CIN in 48 hours

The mean values are reported, while the central line indicates the 50th percentile (median value). The box contains values between the 25th and 75th percentiles, and the whiskers denote the values between the 5th and 95th percentiles.

Figure 4. Odds ratio chart of risk factors associated with CIN

Forest plot displaying odd ratios (OR) in triangles with 95% Wald confidence limits for CIN (contrast-induced nephropathy) after the univariate analysis (values related to Table 5). The following were included: PRL (preexisting renal lesion), HF (heart failure), age >65, contrast quantity, Hb (hemoglobin), and DM (diabetes mellitus).