Poh WY, Omar MS, Tan HP. Predictive factors for contrast-induced acute kidney injury in high-risk patients given N-acetylcysteine prophylaxis.
Ann Saudi Med 2018;
38:269-276. [PMID:
30078025 PMCID:
PMC6086672 DOI:
10.5144/0256-4947.2018.269]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND
Contrast-induced acute kidney injury (CI-AKI) is rec.ognized as a common complication of radiographic contrast-enhanced procedures. N-acetylcysteine (NAC) is commonly prescribed, but CI-AKI can still develop despite NAC administration as prophylaxis.
OBJECTIVE
Identify the predictive factors for development of CI-AKI in patients prescribed NAC.
DESIGN
Prospective, cross-sectional.
SETTING
A tertiary hospital in Malaysia.
PATIENTS AND METHODS
All adult patients who were prescribed NAC for prevention of CI-AKI were identified through an NAC drug us.age monitoring card maintained by the inpatient pharmacy. The study was conducted from March to July 2017.
MAIN OUTCOME MEASURES
Statistically significant predictive fac.tors for development of CI-AKI despite NAC administration.
SAMPLE SIZE
152 RESULTS: The most commonly recognized risk factors for CI-AKI present in the study population were renal impairment (n=131, 86.2%), anemia (n=107, 70.4%), and diabetes mellitus (n=90, 59.2%). Hydration therapy was initiated in 128 patients (84.2%) prior to the contrast-enhanced procedure. Sixty-one (40.1%) were treated with nephrotoxic medications concomitantly with NAC. Fifteen (9.9%) patients developed AKI. Hypotension (OR: 6.02; 95% CI 1.25-28.97) and use of high contrast volume (OR: 6.56; 95% CI: 1.41-30.64) significantly increased the odds for AKI. Prior hydration therapy (OR: 0.13; 95% CI 0.03-0.59) showed protective effects.
CONCLUSION
The risk predictors identified for CI-AKI were hypotension, high contrast volume and prior hydration therapy.
LIMITATION
May not have identified other confounding factors for development of CI-AKI.
CONFLICT OF INTEREST
None.
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