NDT Advance Access originally published online on February 26, 2007
Nephrology Dialysis Transplantation 2007 22(6):1794-1795; doi:10.1093/ndt/gfm074
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The incidence and predictors of contrast-induced nephropathy in adequately hydrated elderly patients with impaired renal function
Email: bkkoo{at}snu.ac.kr or hyosoo{at}snu.ac.krSir,
Contrast-induced nephropathy (CIN) is a potentially serious complication of contrast media use [1,2], whose incidence increases with age and decreased renal function [3–6]. As lifespan increases, we can expect to see more and more patients referred for diagnostic and interventional procedures using contrast media who are over the age of 60 years, and with renal impairment. Therefore, elderly patients with impaired renal function represent a group at significant risk of developing CIN. Although adequate hydration is known to protect against the development of CIN [7–10], other conditions may still place certain patients at risk [3,4,7]. In this letter, we discuss the results of our investigation into the incidence and predictors of CIN in prospectively enrolled elderly patients over the age of 60 years, with impaired renal function, undergoing coronary angiography (CAG).2
In 247 consecutively enrolled elderly patients with baseline calculated creatinine clearance <60 ml/min, who were adequately hydrated pre- and post-procedure, and used iodixanol, an iso-osmolar non-ionic contrast media exclusively, the incidence of CIN was 4.1% (10/247). This is lower than the 17% incidence of CIN reported in elderly patients (age > 60 years) in one study [6], and comparable with the 3% incidence in well-hydrated elderly patients receiving iso-osmolar non-ionic contrast media in another study [8]. In concordance with previous reports, the incidence of CIN was higher as baseline Creatinine Clearance (CCr) declined, 2.3%, 4.8% and 50% respectively for those with CCr 40–60, 20–40 and <20 ml/min.
On univariate analysis, patients that developed CIN had significantly lower high density lipoprotein (HDL)-cholesterol, lower haematocrit levels, lower left ventricular function and significantly higher blood urea nitrogen (BUN) levels. In addition, there were more patients with diabetes mellitus, reduced left ventricular (LV) function, female gender, and microalbuminuria or proteinuria in the group that developed CIN (Table 1). By multivariate analysis, reduced LV function (OR 7.8, CI 1.4–43.0, P < 0.05) and the lowest tertile of baseline calculated creatinine clearance (OR 31.8, CI 1.9–532.9, P < 0.05) were the only independent predictors of CIN. There was an increased risk of CIN in those with microalbuminuria or overt proteinuria (OR 8.2, CI 0.9–78.1), but the significance was only marginal ( P = 0.06) (Table 2).
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Our present results suggest that the incidence of contrast-induced nephropathy in high risk elderly patients with impaired renal function can be relatively low with adequate pre- and post-procedure hydration and the use of iso-osmolar non-ionic contrast media. However, patients with reduced LV systolic function [left ventricular ejection fraction] (LVEF)<40%, and those with severe renal dysfunction (calculated CCr <20 ml/min) may still be at high risk and may require additional measures to prevent the development of CIN when undergoing procedures using contrast media.
1Cardiovascular Center
Seoul National University
Hospital Seoul
2Department of Internal Medicine
Hallym University Sacred Heart Hospital
3Heart Center
Seoul National University
Bundang Hospital
Gyung-Gi Do, Korea
Acknowledgements
This study was supported by a grant from the Clinical Research Center for Ischemic Heart Disease sponsored by the Ministry of Health & Welfare, Republic of Korea (0412-CR02-0704-0001).
Conflict of interest statement. None declared.
References
- Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med (1983) 74:243–248.[CrossRef][ISI][Medline]
- Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis (2002) 39:930–936.[CrossRef][ISI][Medline]
- Goldenberg I, Matetzky S. Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ (2005) 172:1461–1471.
[Abstract/Free Full Text] - Maeder M, Klein M, Fehr T, Rickli H. Contrast nephropathy: review focusing on prevention. J Am Coll Cardiol (2004) 44:1763–1771.
[Abstract/Free Full Text] - Morcos SK, Thomsen HS, Webb JA. Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol (1999) 9:1602–1613.[CrossRef][ISI][Medline]
- Kohli HS, Bhaskaran MC, Muthukumar T, et al. Treatment-related acute renal failure in the elderly: a hospital-based prospective study. Nephrol Dial Transplant (2000) 15:212–217.
[Abstract/Free Full Text] - Toprak O, Cirit M. Risk factors for contrast-induced nephropathy. Kidney Blood Press Res (2006) 29:84–93.[CrossRef][ISI][Medline]
- Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med (2003) 348:491–499.
[Abstract/Free Full Text] - Trivedi HS, Moore H, Nasr S, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract (2003) 93:C29–C34.[CrossRef][ISI][Medline]
- Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med (2002) 162:329–336.
[Abstract/Free Full Text]
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