Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days

Chong-Huai Gu; Xiao-Zeng Wang; Ya-Ling Han; Quan-Min Jing; Li-Li Ren; Yan Zhang; Jun-Yin Peng; Xin Zhao

doi:10.1186/s40779-020-00243-x

Your Location：

Home >

Browse articles >

Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days

RESEARCH | Updated：2023-06-05

- Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days
- Military Medical Research Vol. 7, Issue 3, Pages: 350-358(2020)
- Affiliations：
  
  1.Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang 110840, China.
  2.Department of Cardiovascular, Anqing Municipal Hospital, Anqing 246000, Anhui, China.
- Author bio：
  
  * zhaoxin81830@sina.com
- Funds：
- DOI：10.1186/s40779-020-00243-x
  CLC：
- Published：2020-09
- Accepted：
Scan QR Code
GU et al.: Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days. Mil Med Res, 2020, 7: 14
DOI：

GU et al.: Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days. Mil Med Res, 2020, 7: 14 DOI： 10.1186/s40779-020-00243-x.

摘要

Abstract

Background:

None of study mentioned about contrast-induced acute kidney injury (CI-AKI) in people who have received contrast agents twice within in a short period of time. This study is trying to identify the predictors.

Methods:

We enrolled 607 patients between Oct. 2010 and Jul. 2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region. The primary outcome was CI-AKI within 72 h after contrast agent exposure. Patients were divided into groups A (

=559) and group B (

=48) according to whether CI-AKI occurred after the second agent.

Results:

Patients in group B (CI-AKI occurred after the second agent) had a more rapid heart rate and more usage of diuretics and digitalis. In group B

CI-AKI occurred more frequently after the first agent. Multivariate logistic regression showed that diuretic (

=0.006) and intra-aortic balloon pump (IABP) usage (

=0.012) were independent predictors of CI-AKI after the first agent. Angiotensin-converting enzyme inhibitor/Angiotensin II receptor antagonist (ACEI/ARB) usage (

=0.039)

IABP usage (

=0.040) and CI-AKI occurring after administration of the first agent (

=0.015) were independent predictors of CI-AKI after the second. Furthermore

dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1–3 days after the first exposure than within 4–6 days (12.4%

. 5.0%

=0.008) or ≥7 days (12.4%

. 6.4%

=0.039).

Conclusions:

Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent. The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure

ACEI/ARB usage

and IABP usage. More importantly

a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.

关键词

Keywords

references

McCullough PA . Contrast-induced acute kidney injury . J Am Coll Cardiol . 2008 ; 51 ( 15 ): 1419 - 28 .

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 .

Nash K , Hafeez A , Hou S . Hospital-acquired renal insufficiency . Am J Kidney Dis . 2002 ; 39 : 930 - 6 .

Sadeghi HM , Stone GW , Grines CL , Mehran R , Dixon SR , Lansky AJ , et al . Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction . Circulation . 2003 ; 108 : 2769 - 75 .

Marenzi G , Lauri G , Assanelli E , Campodonico J , De Metrio M , Marana I , et al . Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction . J Am Coll Cardiol . 2004 ; 44 : 1780 - 5 .

Solomon RJ , Natarajan MK , Doucet S , Sharma SK , Staniloae CS , Katholi RE , et al . Cardiac angiography in renally impaired patients (CARE) study: a radomized double-blind trail of contrast-induced nephropathy in patients with chronic kidney disease . Circulation . 2007 ; 115 : 3189 - 96 .

Mehran R , Aymong ED , Nikolsky E , Lasic Z , Iakovou I , Fahy M , 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 .

Wi J , Ko YG , Kim JS , Kim BK , Choi D , Ha JW , et al . Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on longterm outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention . Heart . 2011 ; 97 : 1753 - 7 .

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 : 765 - 72 .

Pyxaras SA , Sinagra G , Mangiacapra F , Perkan A , Di Serafino L , Vitrella G , et al . Contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention without acute left ventricular ejection fraction impairment . Am J Cardiol . 2013 ; 111 : 684 - 8 .

Solomon R , Dauerman HL . Contrast-induced acute kidney injury . Circulation . 2010 ; 122 : 2451 - 5 .

Seeliger E , Sendeski M , Rihal CS , Persson PB . Contrast-induced kidney injury: mechanisms, risk factors, and prevention . Eur Heart J . 2012 ; 33 : 2007 - 15 .

Mehta RL , Kellum JA , Shah SV , Molitoris BA , Ronco C , Warnock DG , et al . Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury . Crit Care . 2007 ; 11 : R31 .

Bellomo R , Ronco C , Kellum JA , Mehta RL , Palevsky P , Acute Dialysis Quality Initiative workgroup . Acute renal failure -definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) group . Crit Care . 2004 ; 8 ( 4 ): R204 - 12 .

Alessandri N , Lanzi L , Garante CM , Tersigni F , Sergiacomi R , Petrassi M , et al . Prevention of acute renal failure postcontrast imaging in cardiology: a randomized study . Eur Rev Med Pharmacol Sci . 2013 ; 17 ( Suppl 1 ): 13 - 21 .

National Kidney Foundation . K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification . Am J Kidney Dis . 2002 ; 39 ( 2 Suppl 1 ): S1 - 266 .

Thygesen K , Alpert JS , Jaffe AS , Simoons ML , Chaitman BR , White HD , et al . Third universal definition of myocardial infarction . J Am Coll Cardiol . 2012 ; 60 ( 16 ): 1581 - 98 .

World Health Organization , Regional Office for South-East Asia . Prevention of iron deficiency anaemia in adolescents . WHO Regional Office for South-East Asia . 2011 . https://apps.who.int/iris/handle/10665/205656 https://apps.who.int/iris/handle/10665/205656 .

Ibanez B , James S , Agewall S , Antunes MJ , Bucciarelli-Ducci C , Bueno H , et al . 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) . Eur Heart J . 2018 ; 39 ( 2 ): 119 - 77 .

Ejaz AA , Mohandas R . Are diuretics harmful in the management of acute kidney injury ? Curr Opin Nephrol Hypertens . 2014 ; 23 ( 2 ): 155 - 60 .

Solomon R . Contrast-induced acute kidney injury: is there a risk after intravenous contrast ? Clin J Am Soc Nephrol . 2008 ; 3 ( 5 ): 1242 - 3 .

Mehran R , Nikolsky E . Contrast-induced nephropathy: definition, epidemiology, and patients at risk . Kidney Int . 2006 ; 69 : S11 - 5 .

Fuiano G , Mancuso D , Indolfi C , Mongiardo A , Sabbatini M , Conte G , et al . Early detection of progressive renal dysfunction in patients with coronary artery disease . Kidney Int . 2005 ; 68 ( 6 ): 2773 - 80 .

Gupta RK , Kapoor A , Tewari S , Sinha N , Sharma RK . Captopril for preventing of contrast-induced nephropathy in diabetic patients: a randomized study . Indian Heart J . 1999 ; 51 : 521 - 6 .

Hashemi M , Kharazi A , Shahidi S . Captopril for prevention of contrast induced nephropathy in patients undergoing coronary angioplasty: a double blind placebo controlled clinical trial . J Res Med Sci . 2005 ; 10 ( 5 ): 305 - 8 .

Duan SB , Wang YH , Liu FY , Xu XQ , Wang P , Zou Q , et al . The protective role of telmisartan against nephrotoxicity induced by X-ray contrast media in rat model . Acta Radiol . 2009 ; 50 ( 7 ): 754 - 9 .

Kiski D , Stepper W , Brand E , Breithardt G , Reinecke H . Impact of reninangiotensin-aldosterone blockade by angiotensin-converting enzyme inhibitors or AT-1 blockers on frequency of contrast medium-induced nephropathy: a post-hoc analysis from the Dialysis-versus-Diuresis (DVD) trial . Nephrol Dial Transplant . 2010 ; 25 ( 3 ): 759 - 64 .

Sendeski MM . Pathophysiology of renal tissue damage by iodinated contrast media . Clin Exp Pharmacol Physiol . 2011 ; 38 ( 5 ): 292 - 9 .

Park JH , Yoon HJ , Won KB , Cho YK , Park HS , Kim HS , et al . Increased risk of contrast induced nephropathy in consecutive percutaneous coronary intervention after multidetector computed tomography within short interval . Eur Heart J . 2015 ; 36 : 38 .

Waybill M , Waybill P . Contrast media-induced nephrotoxicity: identification of patients at risk and algorithms for prevention . J Vasc Interv Radiol . 2001 ; 12 ( 1 ): 3 - 9 .

Owen RJ , Hiremath S , Myers A , Fraser-Hill M , Barrett BJ . Canadian Association of Radiologists consensus guidelines for the prevention of contrast-induced nephropathy: update 2012 . Can Assoc Radiol J . 2014 ; 65 ( 2 ): 96 - 105 .

Kim JH , Yang JH , Choi SH , Song YB , Hahn JY , Choi JH , et al . Predictors of outcomes of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with chronic kidney disease . Am J Cardiol . 2014 ; 114 ( 12 ): 1830 - 5 .

Senoo T , Motohiro M , Kamihata H , Yamamoto S , Isono T , Manabe K , et al . Contrast-induced nephropathy in patients undergoing emergency percutaneous coronary intervention for acute coronary syndrome . Am J Cardiol . 2010 ; 105 ( 5 ): 624 - 8 .

Bartholomew BA , Harjai KJ , Dukkipati S , Boura JA , Yerkey MW , Glazier S , et al . Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification . Am J Cardiol . 2004 ; 93 ( 12 ): 1515 - 9 .

Goldberg A , Hammerman H , Petcherski S , Zdorovyak A , Yalonetsky S , Kapeliovich M , et al . Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction . Am Heart J . 2005 ; 150 ( 2 ): 330 - 7 .

Prasitlumkum N , Kanitsoraphan C , Kittipibul V , Rattanawong P , Chongsathidkiet P , Cheungpasitporn W , et al . Baseline atrial fibrillation is associated with contrast-induced nephropathy after cardiac catheterization in coronary artery disease: systemic review and meta-analysis . Clin Cardiol . 2018 ; 41 ( 12 ): 1555 - 62 .

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

No data

Related Author

No data

Related Institution

No data

⁰