NDT Advance Access originally published online on November 7, 2006
Nephrology Dialysis Transplantation 2007 22(3):819-826; doi:10.1093/ndt/gfl636
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Impact of diabetic and pre-diabetic state on development of contrast-induced nephropathy in patients with chronic kidney disease
1Department of Nephrology, 2Department of First Cardiology, 3Department of Second Internal Medicine and 4Department of Radiology, Ataturk Training and Research Hospital, Izmir, Turkey
Correspondence and offprint requests to: Omer Toprak, MD, Ataturk Training and Research Hospital, Department of Nephrology, 35360 Izmir, Turkey. Email: info{at}omertoprak.com
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Abstract |
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Background. The aim of the present study was to assess the influence of diabetic and pre-diabetic state on the development of contrast-induced nephropathy (CIN) in chronic kidney disease patients undergoing coronary angiography.
Methods. A total of 421 patients with Cockcroft clearance between 15 and 60 ml/min were divided into three groups [diabetes mellitus (DM), n = 137; pre-diabetes (pre-DM), n = 140; and normal fasting glucose (NFG), n = 144]. CIN was defined as an increase of 
25% in creatinine over baseline within 48 h of angiography, DM as glucose 126 mg/dl, pre-DM as glucose between 100 and 125 mg/dl and NFG as glucose <100 mg/dl.
Results. CIN occurred in 20% of the DM [relative risk (RR) 3.6, P = 0.001], 11.4% of the pre-DM (RR 2.1, P = 0.314) and 5.5% of the NFG group. The decrease of glomerular filtration rate (GFR) was higher in DM and pre-DM (P = 0.001 and P = 0.002, respectively). GFR 
30 ml/min (RR 19.22), multivessel involvement (RR 7.59), hyperuricaemia (RR 3.95), use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker (RR 2.70) and DM (RR 2.34) were predictors of CIN. Length of hospital stay was 2.45 ± 1.45 day in DM, 2.27 ± 0.68 day in pre-DM and 1.97 ± 0.45 day in NFG (P < 0.001, DM vs NFG and P = 0.032, pre-DM vs NFG). The rate of major adverse cardiac events was 8.7% in DM, 5% in pre-DM and 2.1% in NFG (P = 0.042, DM vs NFG). Haemodialysis was required in 3.6% of DM and 0.7% in pre-DM (P = 0.036, DM vs NFG), and the total number of haemodialysis sessions during 3 months was higher in DM and pre-DM (P < 0.001). Serum glucose 124 mg/dl was the best cut-off point for prediction of CIN.
Conclusion. Our data support that patients with DM are at a higher risk of developing CIN, but patients with pre-DM are not at as high a risk for developing CIN as diabetes patients.
Keywords: contrast-induced nephropathy; coronary angiography; diabetes mellitus; pre-diabetes; renal insufficiency
Received for publication: 20. 8.06
Accepted in revised form: 3.10.06
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