Nefropatía inducida por contraste y fracaso renal agudo tras cateterismo cardiaco urgente: incidencia, factores de riesgo y pronóstico

doi:10.1157/13111234

Revista Española de Cardiología

Volume 60, Issue 10, October 2007, Pages 1026-1034

https://doi.org/10.1157/13111234 Get rights and content

Introducción y objetivos

Nuestro objetivo fue analizar la incidencia, los factores predictores y el pronóstico de la insuficiencia renal aguda (IRA) tras un cateterismo cardiaco urgente.

Métodos

Estudiamos a 602 pacientes consecutivos sometidos a cateterismo urgente. Se definió IRA como un incremento absoluto del valor de creatinina sérica ≥ 0,5 mg/dl en las 72 h siguientes al procedimiento. En una primera cohorte de 315 pacientes evaluamos los factores predictores y el pronóstico de IRA y elaboramos una clasificación de riesgo, que validamos en una segunda cohorte de 287 pacientes. La mediana (rango intercuartílico) de seguimiento fue de 1,3 (0,8-2) años.

Resultados

De los 602 pacientes, 72 (12%) desarrollaron IRA. En la cohorte de 315 pacientes, los predictores independientes de IRA fueron: shock cardiogénico al ingreso (odds ratio [OR] = 4,56), diabetes mellitus (OR = 2,98), tiempo a la reperfusión > 6 h (OR = 3,18), localización anterior del infarto (OR = 2,61) y valores basales de creatinina ≥ 1,5 mg/dl (OR = 3,51) y de urea sérica ≥ 50 mg/dl (OR = 3). Se construyó una clasificación de riesgo usando esas variables (shock cardiogénico = 3 puntos; demás variables = 2 puntos); los pacientes de la cohorte de validación fueron clasificados en 5 categorías de riesgo: 0 puntos, el 1,2% de incidencia de IRA; 2-3 puntos, el 8,7%; 4-5 puntos, el 12,5%; 6-7 puntos, el 46,2%; ≥ 8 puntos, el 66,7% (p < 0,0001). En el análisis de regresión de Cox, la IRA resultó ser un poderoso predictor de mortalidad (hazard ratio [HR] = 5,97; intervalo de confianza [IC] del 95%, 2,54-14,03; p < 0,0001) y de eventos cardiovasculares mayores (HR = 3,29; IC del 95%, 1,61-6,75; p = 0,001).

Conclusiones

La incidencia de IRA tras un cateterismo urgente es elevada. El shock cardiogénico, la diabetes mellitus, la localización del infarto, el tiempo a la reperfusión y la creatinina y la urea séricas son predictores de IRA. Los pacientes que desarrollaron esta complicación presentaron mayor tasa de mortalidad y de eventos cardiovasculares mayores.

Introduction and objectives

The aim was to investigate the incidence and prognosis of, and predictive factors for, acute renal failure following emergent cardiac catheterization.

Methods

The study involved 602 consecutive patients who underwent emergent cardiac catheterization. Acute renal failure (ARF) was defined as an increase in serum creatinine level ≥0.5 mg/dL within 72 hours following the procedure. Predictive factors for and the prognosis of ARF were evaluated in an initial cohort of 315 patients, and a risk score was derived. The risk score was validated in a second cohort of 287 patients. The median (interquartile) follow-up time was 1.3 years (0.8-2.0 years).

Results

Seventy-two of the 602 patients (12.0%) developed ARF. In the initial cohort of 315 patients, the following factors were predictors of ARF: cardiogenic shock at admission (odds ratio [OR] 4.56), diabetes mellitus (OR 2.98), time to reperfusion >6 hours (OR 3.18), anterior myocardial infarction (OR 2.61), baseline serum creatinine level ≥1.5 mg/dL (OR 3.51), and baseline serum urea level ≥50 mg/dL (OR 3.00). A risk score based on these variables was constructed in which cardiogenic shock = 3 points and each of the remaining variables = 2 points. Patients in the validation cohort were divided into five risk categories: in those with 0 points, the incidence of ARF was 1.2%; with 2-3 points, 8.7%; with 4–5 points, 12.5%; with 6-7 points, 46.2%; and with ≥8 points, 66.7% (P<.0001). Cox regression analysis showed that ARF was a powerful predictor of total mortality (hazard ratio [HR] 5.97, 95% confidence interval [CI] 2.54–14.03; P<.0001) and of a major cardiovascular event (HR 3.29, 95% CI 1.61–6.75; P=.001).

Conclusions

The incidence of ARF after emergent cardiac catheterization is high. Cardiogenic shock, diabetes mellitus, myocardial infarction location, time to reperfusion, and serum creatinine and urea levels are predictors of ARF. Patients who developed this complication had higher mortality and major cardiovascular events rates.

Bibliografía (18)

P.A. McCullough et al.
Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality
Am J Med
(1997)
G. Dangas et al.
Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables
Am J Cardiol
(2005)
R. Mehran et al.
Contrast-induced nephropathy: definition, epidemiology, and patients at risk
Kidney Int Suppl
(2006)
G. Marenzi et al.
Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
(2004)
R. Mehran 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)
R. Solomon et al.
How to prevent contrast-induced nephropathy and manage risk patients: practical recommendations
Kidney Int Suppl
(2006)
C.S. Baker et al.
A rapid protocol for the prevention of contrast-induced renal disfunction: the RAPPID study
J Am Coll Cardiol
(2003)
A. Recio-Mayoral et al.
The reno-protective effect of hydration with sodium bicarbonate plus N-acetylcysteine in patients undergoing emergency percutaneous coronary intervention: the RENO Study
J Am Coll Cardiol
(2007)
R.S. Wright et al.
Acute myocardial infarction and renal dysfunction: a high-risk combination
Ann Intern Med
(2002)

There are more references available in the full text version of this article.

Cited by (68)

Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction: Is it Affected by Treatment Strategy?
2019, Global Heart
Contrast-induced nephropathy (CIN) is a frequent complication after percutaneous coronary intervention (PCI) and severely affects morbidity and mortality, especially in patients with ST-segment elevation myocardial infarction.
This study sought to determine the incidence, risk factors, and in-hospital outcome of CIN in patients with ST-segment elevation myocardial infarction managed by pharmacoinvasive strategy (PIS) versus those managed by primary PCI (PPCI).
The study was conducted on 670 patients with ST-segment elevation myocardial infarction divided into 2 groups: group I (PPCI group) and group II (PIS group), the 2 groups were compared with each other for the incidence of CIN, risk factors, and in-hospital major adverse cardiac events.
The incidence of CIN in the PIS group (30 patients, 8.8%) was lower than PPCI group (36 patients, 10.9%); however, there was no statistically significant difference between the 2 groups (p = 0.365). Multivariate regression analysis showed that advanced age >60 years (odds ratio [OR] = 4.453; 95% confidence interval [CI]: 2.489 to –7.967; p = 0.001), history of diabetes mellitus (OR = 2.366; 95% CI: 1.298 to –4.315; p = 0.005) and hypertension (OR = 1.930; 95% CI: 1.053 to –3.539; p = 0.034), volume of contrast agent >180 ml (OR = 2.276; 95% CI: 1.290 to –4.016; p = 0.005), and cardiogenic shock (OR = 4.098; 95% CI: 1.726 to –9.728; p = 0.001) were the independent predictors of CIN. Mortality and major adverse cardiac events were significantly higher in patients with CIN.
The incidence of CIN was slightly lower in PIS as compared to PPCI; however, this reduction was not statistically significant. The independent predictors of CIN were advanced age, history of diabetes mellitus and hypertension, high dose of contrast agent, and cardiogenic shock.
A novel risk score model for prediction of contrast-induced nephropathy after emergent percutaneous coronary intervention
2017, International Journal of Cardiology
Citation Excerpt :
Besides, in Alberto Bouzas-Mosquera's 5 factor CIN score including cardiogenic shock, diabetes mellitus, urea levels have shown predictive value for ARF after urgent cardiac catheterization. Unfortunately, they failed to evaluate the risk score model's predictive value for long-term prognosis with median follow-up time of only 1.3 years [28]. Our model using 4 simple factors demonstrated similar accuracy compared to Mehran's and ACEF score, in predicting CIN development and long-term prognosis.
A few studies developed simple risk model for predicting CIN with poor prognosis after emergent PCI. The study aimed to develop and validate a novel tool for predicting the risk of contrast-induced nephropathy (CIN) in patients undergoing emergent percutaneous coronary intervention (PCI).
692 consecutive patients undergoing emergent PCI between January 2010 and December 2013 were randomly (2:1) assigned to a development dataset (n = 461) and a validation dataset (n = 231). Multivariate logistic regression was applied to identify independent predictors of CIN, and established CIN predicting model, whose prognostic accuracy was assessed using the c-statistic for discrimination and the Hosmere Lemeshow test for calibration.
The overall incidence of CIN was 55(7.9%). A total of 11 variables were analyzed, including age > 75 years old, baseline serum creatinine (SCr) > 1.5 mg/dl, hypotension and the use of intra-aortic balloon pump(IABP), which were identified to enter risk score model (Chen). The incidence of CIN was 32(6.9%) in the development dataset (in low risk (score = 0), 1.0%, moderate risk (score:1–2), 13.4%, high risk (score ≥ 3), 90.0%). Compared to the classical Mehran's and ACEF CIN risk score models, the risk score (Chen) across the subgroup of the study population exhibited similar discrimination and predictive ability on CIN (c-statistic:0.828, 0.776, 0.853, respectively), in-hospital mortality, 2, 3-years mortality (c-statistic:0.738.0.750, 0.845, respectively) in the validation population.
Our data showed that this simple risk model exhibited good discrimination and predictive ability on CIN, similar to Mehran's and ACEF score, and even on long-term mortality after emergent PCI.
Adverse effects of drugs on the kidney
2016, European Journal of Internal Medicine
Citation Excerpt :
In the presence of comorbidities, renal toxicity is significantly more likely [34], as even volumes < 100 ml can be dangerous. The incidence of CIN is 0.15% [43], 1.6% in selective clinical conditions [44], it reaches 12% in hospitalized patients [45], surging to 50% in high-risk situations, like in ICU patients [46–48]. The risk, proportional to the severity of pre-existing renal failure, is factored by age > 70, hemodynamic instability, nephrotic syndrome and transplanted kidney [43–50].
The number of drugs presently marketed is countless, their prescription is relentlessly growing, such that the likelihood of adverse effects is strikingly increasing. As many drugs are cleared by the body through kidney excretion, renal adverse events are likely. In this review we shall concisely describe the pathophysiologic mechanisms of renal damage by drugs, the different clinical presentations outlining renal toxicity in the course of pharmacologic treatment, and the main offending agents.
Predicting contrast induced nephropathy post coronary intervention: A prospective cohort study
2015, Egyptian Heart Journal
Citation Excerpt :
There was a high incidence of CIN in our study even in patients with normal renal function and at low risk. In accordance with Bouzas-Mosquera et al. 13 who reported 12% incidence of CIN however, his incidence was in a high risk group undergoing primary PCI. Although the risk of CIN after PCI in the general population is low (0.6–3%, depending on the definition used),14 the incidence can be considerably higher in risk subgroups.15–17
The purpose of our study was to assess the incidence and predictors of contrast induced nephropathy (CIN) in unselected patients undergoing coronary intervention either coronary angiography (CA) or percutaneous coronary interventions (PCI), at Assiut university hospitals.
CIN is a frequent, potentially lethal complication after coronary intervention. It is the 3rd most common cause of hospital-acquired acute renal failure.
This is an observational prospective cohort study. Two hundred consecutive patients between December 2011 and August 2012 underwent CA and PCI were enrolled in the study. Blood samples were collected at baseline and 3 days after interventions. All patients were followed up for 2 weeks for major adverse events.
CIN was observed in 23 (11.5%) patients. According to Mehran risk score, 84.5% of our patients had low risk for CIN, 15.5% had moderate risk for CIN, and no one had high risk score.
Multivariate logistic regression analysis of predictors for CIN, showed that the use of high osmolar contrast media (CM) (Telebrix) was associated with 4 times higher incidence of CIN than the use of low osmolar CM (Ultravest) (OR = 4.07; 95% CI = 1.1–15.1). None of our patients had clinical signs or symptoms of acute renal failure, or required haemodialysis at 2 weeks of follow up.
Although most of our study population was at low risk, the incidence of CIN was relatively high due to the use of high osmolar CM. Further studies are needed for cost effectiveness in light of negligible clinical impact.
Applicable Machine Learning Model for Predicting Contrast-induced Nephropathy Based on Pre-catheterization Variables
2024, Internal Medicine
Incomplete Recovery from the Radiocontrast-Induced Dysregulated Cell Cycle, Adhesion, and Fibrogenesis in Renal Tubular Cells after Radiocontrast (Iohexol) Removal
2023, International Journal of Molecular Sciences

View all citing articles on Scopus

View full text

Artículo originalNefropatía inducida por contraste y fracaso renal agudo tras cateterismo cardiaco urgente: incidencia, factores de riesgo y pronósticoContrast-Induced Nephropathy and Acute Renal Failure Following Emergent Cardiac Catheterization: Incidence, Risk Factors and Prognosis

Introducción y objetivos

Métodos

Resultados

Conclusiones

Introduction and objectives

Methods

Results

Conclusions

Am J Med

Am J Cardiol

Kidney Int Suppl

J Am Coll Cardiol

J Am Coll Cardiol

Kidney Int Suppl

J Am Coll Cardiol

J Am Coll Cardiol

Acute myocardial infarction and renal dysfunction: a high-risk combination

Ann Intern Med

Artículo original
Nefropatía inducida por contraste y fracaso renal agudo tras cateterismo cardiaco urgente: incidencia, factores de riesgo y pronósticoContrast-Induced Nephropathy and Acute Renal Failure Following Emergent Cardiac Catheterization: Incidence, Risk Factors and Prognosis