Incidence and risk factors of contrast-induced nephropathy in interventional cardiology procedures

Incidencia y factores de riesgo asociados con nefropatía inducida por medios de contraste en procedimientos intervencionistas de cardiología

Introduction: contrast-induced nephropathy (CIN) is the acute kidney injury following diagnostic or interventional procedures. It is the third cause of hospital-acquired acute renal insufficiency. This research intended to establish the risk factors for developing CIN in hospitalized patients undergoing coronary angiography at Hospital de San José of Bogotá, during a 3-year period. Methods: a  retrospective  study  in  a  cohort  of  CIN  patients  following  contrast  exposure  and  prophylactic  strategies  as  hydration,  sodium  bicarbonate  or  N-acetylcysteine.  Patients  seen  between  2014  and  2016  were  included.  CIN  is  defined  as  an  elevation  of  serum  creatinine of 0.5 mg/dL or by 25% from baseline within the first 72 hours after contrast administration. Of 495 patients, 15 were excluded for prior hemodialysis. Stata 13 was used for clinical data recording and multivariate statistical analysis. Results: in 480 patients  CIN  incidence  was  13.1%;  a  hemoglobin  value  greater  than  13  gr/dL  showed  to  be  a  protective  factor  for  CIN  in  men:  0.29 (p=0.004). The presence of risk factors as baseline creatinine greater than 1.5 mg/dL OR: 2.56 (IC 95: 1.35-4.85; p=0.004), and chronic renal insufficiency and diabetes mellitus OR: 2.73 (IC 95: 1.25 – 5.95; p=0,005) increased CIN prevalence. Other factors such as age, cardiac dysfunction, volume of contrast agent used, prior acute myocardial infarction (AMI) and the use of nephron-protective  strategies  showed  no  significant  association.  CIN-related  mortality  was  9.5%  and  hemodialysis-related  mortality  was  2.5%. Conclusions:  the  incidence  of  CIN  was  associated  with  an  increase  in  mortality;  contributing  risk  factors  were  baseline  creatinine  greater  than  1.5  mg/dL,  pre-existent  chronic  renal  insufficiency  and  diabetes  mellitus.  A  normal  hemoglobin  value  showed to be a protective factor in men.

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