Race and contrast-induced nephropathy in patients undergoing coronary angiography and cardiac catheterization

Contrast Media Volume to Creatinine Clearance Ratio in Predicting Nephropathy in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

The studies investigated the predictive value of the contrast media volume to creatinine clearance ratio (V/CrCl) for contrast-induced nephropathy (CIN) after a percutaneous coronary intervention (PCI) showed conflicting results and different cut-off values. The objective is to evaluate V/CrCl in the prediction of CIN after PCI. PubMed, Embase, and the Cochrane library were searched for eligible studies published from inception to November 2020. The optimal cut-off points of V/CrCl for predicting CIN were examined using odds ratios (ORs) and 95% confidence intervals (CIs). The random-effect model was used for analyses. Six studies (8 datasets, 16 899 patients) were included. V/CrCl was associated with CIN (OR = 2.67, 95% CI: 1.88-3.78, P < .001; I² = 79.3%, P_{heterogeneity} < .001). V/CrCl was associated with CIN in Asians (OR = 2.13, 95% CI: 1.52-2.98, P = .022; I² = 68.8%, P_{heterogeneity} < .001) and Europeans (OR = 3.87, 95% CI: 1.77-8.45, P < .001; I² = 85.1%, P_{heterogeneity} = .001). The association between V/CrCl and CIN was observed in the prospective cohort studies (OR = 2.16, 95% CI: 1.42-3.29, P = .009; I² = 78.9%, P_{heterogeneity} < .001) and retrospective cohort studies (OR = 3.31, 95% CI: 1.82-6.02, P < .001; I² = 80.6%, P_{heterogeneity} < .001). The sensitivity analysis showed the results were robust. V/CrCl is independently associated with an increased risk of CIN. V/CrCl could be considered a reliable predictor for the development of CIN in patients undergoing PCI.

Incidence and risk of dialysis therapy within 30 days after contrast enhanced computed tomography in patients coded with chronic kidney disease: a nation-wide, population-based study

Background

Patients with chronic kidney disease (CKD) are considered at risk of contrast-induced acute kidney injury and possible subsequent need for dialysis therapy. Computed tomography (CT) is the most commonly performed examination requiring intravenous iodinated contrast media (ICM) injection. The actual risk of dialysis in CKD patients undergoing CT with ICM remains controversial. Furthermore, it is also uncertain whether these at-risk patients can be identified by means of administrative data. Our study is conducted in order to determine the incidence and risk of dialysis within 30 days after undergoing contrast enhanced CT in CKD coded patients.

Methods

This longitudinal, nation-wide, populated-based study is carried out by analyzing the Taiwan National Health Insurance Research Database retrospectively. Patients coded under the diagnosis of CKD who underwent CT are identified within randomly selected one million subjects of the database. From January 2012 to December 2013, 487 patients had undergone CT with ICM. A total of 924 patients who underwent CT without ICM are selected as the control group. Patients with advanced CKD or intensive care unit (ICU) admissions are assigned to the subgroups for analysis. The primary outcome is measured by dialysis events within 30 days after undergoing CT scans. The cumulative incidence is assessed by the Kaplan–Meier method and log-rank test. The risk of 30-day dialysis relative to the control group is analyzed by the Cox proportional hazards model after adjusting for age, sex, and baseline comorbidities.

Results

The numbers and percentages of dialysis events within 30 days after undergoing CT scans are 20 (4.1%) in the CT with ICM group and 66 (7.1%) in the CT without ICM group (p = 0.03). However, the adjusted hazard ratio (aHR) for 30-day dialysis was 0.84 (95% CI [0.46–1.54], p = 0.57), which is statistically non-significant. In both advanced CKD and ICU admission subgroups, there are also no significant differences in 30-day dialysis risks with the aHR of 1.12 (95% CI [0.38–3.33], p = 0.83) and 0.95 (95% CI [0.44–2.05], p = 0.90), respectively.

Conclusions

Within 30 days of receiving contrast-enhanced CT scans, 4.1% of CKD coded patients required dialysis, which appear to be lower compared with subjects who received non-contrast CT scans. However, no statistically significant difference is observed after adjustments are made for other baseline conditions. Thereby, the application of administrative data to identify patients with CKD cannot be viewed as a risk factor for the necessity to undergo dialysis within 30 days of receiving contrast-enhanced CT scans.

Acute effects of Iodixanol on renal function after intra-arterial administration in patients with end-stage kidney disease

BACKGROUND

Contrast-induced acute kidney injury (CI-AKI), a potentially life-threatening complication of iodinated contrast media in patients with impaired renal function, has attracted increasing attention in recent years. There is overwhelming evidence that the most important pre-disposing factor for a contrast-medium induced nephropathy is the pre-existence of a renal impairment.

METHODS

The registry was performed as a part of a quality management project in the Dresden-Friedrichstadt heart catheter laboratory. In compliance with the Declaration of Helsinki/Somerset West, 9,026 patients were included between 2010 and 2015. 100 patients of these were participants in a chronic dialysis program. All patients were dialyzed on the day before angiography. In all patients a coronary angiography, in 28 patients a stent implantation and in 12 patients a surgical reconstruction had to be performed. Prior to the intervention and one, two and three days thereafter the serum creatinine was measured.

RESULTS

Up to the third day after application of the iodinated contrast medium no significant changes of the serum creatinine (baseline value: 423.3±42.6μmol/l) occurred (ANOVA for repeated measures: p = 0.507). On average, a slight decrease of the serum creatinine was found.All patients remained in their routine dialysis-program. 18 out of 100 died during the next three months after the procedure.

CONCLUSION

The study revealed that the coronary angiography using Iodixanol as iodinated contrast medium did not result in an increase of serum creatinine, which was drastically elevated in these patients before application of the iodinated contrast medium.

Inferior vena cava assessment can predict contrast-induced nephropathy in patients undergoing cardiac catheterization: A single-center prospective study

BACKGROUND

Contrast-induced nephropathy (CIN) following cardiac catheterization remains a considerable clinic challenge. Volume status is very important in the development of CIN. It can be assessed noninvasively by measuring inferior vena cava (IVC) diameters. The aim of this study was to assess whether IVC can be used for prediction of CIN in patient undergoing cardiac catheterization.

METHODS

A total of 269 patients undergoing cardiac catheterization were prospectively enrolled in this study. IVC inspiratory and expiratory diameters were measured by transthoracic echocardiography. Caval index was calculated as the percentage decrease in the IVC diameter during respiration. CIN was defined as a ≥0.5 mg/dL and/or a ≥25% increase in serum creatinine within 72 hour post-procedure.

RESULTS

Contrast-induced nephropathy developed in 46 (17.1%) patients after cardiac catheterization. Caval index was significantly higher in patients with CIN than in patients without CIN (47% [40-64] vs 35% [26-50], P < 0.001). In addition, the used contrast volume (145 [90-217] vs 70 [60-100], P < 0.001) and the frequency of percutaneous coronary intervention (50% vs 17.9%, P < 0.001) were significantly higher in patients with CIN than in patients without CIN. In receiver operating characteristic (ROC) curve analysis, caval index ≥ 41% predicted CIN with a specificity of 69% and sensitivity of 72%. Multivariate analysis indicated that caval index ≥ 41% was an independent predictor of post-procedural CIN development (OR: 3.367, 95% CI: 1.574-7.203, P = 0.002).

CONCLUSIONS

Caval index, a simple and noninvasive echocardiographic marker, is an independent predictor of post-procedural CIN development in patients undergoing cardiac catheterization.

Race, contrast-induced nephropathy and long-term outcomes after coronary and peripheral angiography and intervention

BACKGROUND

Contrast-induced nephropathy (CIN) is a complication of diagnostic angiography and percutaneous coronary and endovascular intervention. We investigated the effect of race on the development of CIN.

METHODS

We studied 4070 predominantly male patients undergoing peripheral and coronary angiography and percutaneous coronary and endovascular intervention. We analyzed the incidence of CIN at 72 h, of renal dysfunction at 3 months as well as the long-term incidence of hemodialysis and of death.

RESULTS

The mean age was 67.2 years. CIN occurred in 92 (7.1%) Caucasian patients and in 42 (6.6%) non-Caucasians at 72 h after the procedure (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.74-1.57; P = 0.69). At 3 months, renal dysfunction was seen in 231 (11.24%) Caucasian patients versus 121 (11.52%) of the non-Caucasian group (OR 0.97, CI 0.77-1.23; P = 0.81). After a follow-up of 5 years, of the 4070 patients, 17 patients (0.64%) of the Caucasian group were placed on dialysis versus 27 (1.88%) of the non-Caucasian group (OR 0.34, 0.18-0.62; P = 0.0004) and 535 (20.28%) of the Caucasian patients had died compared to 293 (20.44%) of the non-Caucasian group (OR = 0.99, 95% CI 0.85-1.17; P = 0.94).

CONCLUSIONS

In this cohort of patients, race was not associated with the development of CIN at 72 h, or the development of renal dysfunction at 3 months post angiography or intervention. In the long-term, the rate of initiation of dialysis was significantly lower in the Caucasian patients but mortality was not.