Prognostic significance of contrast-induced acute kidney injury in chronic coronary artery disease patients

Cover Page

Cite item

Full Text

Abstract

Aim. The aim of our study was to assess the 5-year prognostic significance of contrast-induced acute kidney injury (CI-AKI) in patients with chronic coronary artery disease (CAD). Materials and methods. 561 patients with stable CAD and indications for procedures with intraarterial contrast media administration were included in prospective open cohort study (ClinicalTrials.gov ID NCT04014153). CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was CI-AKI according to KDIGO criteria. The secondary endpoints were total mortality, cardiovascular mortality, myocardial infarction, stroke, gastrointestinal bleeding, acute decompensation of heart failure, coronary artery bypass grafting, repeat percutaneous coronary intervention. Most of the patients, included in the study, were males aged 59.3±11.2 years with arterial hypertension and overweight (BMI 28.8±4.6 kg/m2). Results. CI-AKI was diagnosed in 104 (18.5%) patients. The rate of CI-AKI using the absolute creatinine rise definition was 17 cases (3%). The logistic regression model including age, weight, BMI, female gender, heart failure, proteinuria, arterial hypertension, anemia and baseline serum creatinine, was created. Age, female gender, heart failure, proteinuria and baseline creatinine were statistically significant (p<0.05) risk factors in the model obtained. During 5-year follow-up period CI-AKI seemed to increased the risk of acute decompensation of heart failure and stroke. Conclusion. Elderly female patients suffering from heart failure, proteinuria with higher levels of serum creatinine need more attention and preventive measures before contrast media administration. CI-AKI may indirectly lead to the increased risk of acute decompensation of heart failure and stroke, according to our single-center prospective study. Key words: contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, coronary artery disease, percutaneous coronary intervention, contrast, prognosis, mortality. For citation: Mironova O.Iu., Fomin V.V. Prognostic significance of contrast-induced acute kidney injury in chronic coronary artery disease patients. Consilium Medicum. 2020; 22 (5): 73-76. DOI: 10.26442/20751753.2020.5.200218

About the authors

Olga Iu. Mironova

Sechenov First Moscow State Medical University (Sechenov University)

Email: mironova_o_yu@staff.sechenov.ru
Moscow, Russia

Viktor V. Fomin

Sechenov First Moscow State Medical University (Sechenov University)

Moscow, Russia

References

  1. Hoste EAJ, Bagshaw SM, Bellomo R et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 2015; 41 (8): 1411-23.
  2. Allegretti AS, Steele DJR, David-Kasdan JA et al. Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study. Crit Care 2013; 17 (3): R109. http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=23782899&retmode=ref&cmd=prlinks
  3. James MT, Samuel SM, Manning MA et al. Contrast-Induced Acute Kidney Injury and Risk of Adverse Clinical Outcomes After Coronary Angiography. Circ Cardiovasc Interv 2013; 6 (1): 37-43.
  4. Ribitsch W, Horina JH, Quehenberger F et al. Contrast Induced Acute Kidney Injury and its Impact on Mid-Term Kidney Function, Cardiovascular Events and Mortality. Sci Rep 2019; 9 (1): 1-7. http://dx.doi.org/10.1038/s41598-019-53040-5
  5. Гаскина А.А., Майсков В.В., Виллевальде С.В., Кобалава Ж.Д. Контраст-индуцированное острое повреждение почек после отсроченных чрескожных коронарных вмешательств: распространенность, предикторы развития и исходы. Клин. фармакология и терапия. 2015; 24 (4): 38-42.
  6. Bartholomew BA, Harjai KJ, Dukkipati S et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol 2004; 93 (12): 1515-9.
  7. McCullough PA. Contrast-Induced Acute Kidney Injury. Crit Care Nephrol Third Ed 2017; p. 282-8.
  8. From AM, Bartholmai BJ, Williams AW et al. Mortality associated with nephropathy after radiographic contrast exposure. Mayo Clin Proc 2008; 83 (10): 1095-100.
  9. Weisbord SD, Chen H, Stone RA et al. Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. J Am Soc Nephrol 2006; 17 (10): 2871-7.
  10. Shema L, Mph RN, Mph LO et al. Contrast-Induced Nephropathy among Israeli Hospitalized Patients: Incidence, Risk Factors, Length of Stay and Mortality. Isr Med Assoc J 2009; 11: 460-4.
  11. Гаскина А.А., Майсков В.В., Виллевальде С.В. и др. Распространенность, детерминанты и прогностическое значение контраст-индуцированного острого повреждения почек после первичных чрескожных коронарных вмешательств. Междунар. журн. интервенционной кардиоангиологии. 2015; 41: 40-7.
  12. Kobalava ZD, Villevalde SV, Gaskina AA et al. Contrast-induced acute kidney injury after primary percutaneous coronary interventions: Prevalence, predictive factors, and outcomes. Ter Arkh 2015; 87 (6): 50-5.
  13. Mccullough PA. Contrast-Induced Acute Kidney Injury. Crit Care Med 2008; 51 (15).
  14. Subramanian S, Tumlin J, Ma BB et al. Economic burden of contrast-induced nephropathy: implications for prevention strategies. J Med Econ 2007; 10 (2): 119-34.
  15. McCullough PA. Contrast-Induced Acute Kidney Injury. J Am Coll Cardiol 2016; 68 (13): 1465-73. http://dx.doi.org/10.1016/j.jacc.2016.05.099
  16. Ingelfinger J. Cardiovascular Consequences of Acute Kidney Injury. N Engl J Med 2020; 382: 2238-47.
  17. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012; 2 (1): 3. https://linkinghub.elsevier.com/retrieve/pii/S2157171615310406
  18. Lakhal K, Robert-Edan V, Ehrmann S. In the Name of Contrast-Induced Acute Kidney Injury. Chest 2020; 157 (4): 751-2. https://doi.org/10.1016/j.chest.2019.12.009
  19. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med 2019; 380 (22): 214655. https://doi.org/10.1056/NEJMra1805256

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2020 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).