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Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography
C L Manske1, J M Sprafka, J T Strony
1Department of Medicine, University of Minnesota School of Medicine, Minneapolis.
Insights
Diabetic patients with kidney issues face a high risk of contrast nephropathy after coronary angiography, with dye quantity being a key factor. Limiting radiocontrast volume can help minimize this risk.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Contrast nephropathy is a significant concern in patients with diabetes and azotemia.
- Coronary angiography is a common procedure for evaluating these patients.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes of contrast nephropathy in azotemic diabetic patients undergoing coronary angiography.
- To identify modifiable risk factors for contrast nephropathy.
Main Methods:
- Fifty-nine insulin-dependent diabetic patients with azotemia underwent coronary angiography.
- A control group of 24 azotemic diabetics not undergoing angiography was included.
- Serum creatinine levels were monitored before and after radiocontrast exposure.
Main Results:
- Contrast nephropathy occurred in 50% of patients, defined as a >25% increase in serum creatinine 48 hours post-procedure.
- Significant risk factors included radiocontrast dye quantity and mean arterial pressure < 100 mm Hg.
- Seven patients required short-term dialysis due to acute renal failure.
Conclusions:
- Azotemic diabetic patients are highly susceptible to contrast nephropathy, even with limited radiocontrast volumes.
- Radiocontrast quantity is a critical, previously underappreciated risk factor.
- Minimizing radiocontrast volume to <30 mL may reduce the incidence of contrast nephropathy.
Purpose:
To evaluate the incidence of, risk factors for, and outcome of contrast nephropathy in azotemic diabetic patients undergoing coronary angiography.
Patients And Methods:
Fifty-nine insulin-dependent diabetics with a mean serum creatinine level of 522 mumol/L (5.9 mg/dL) underwent coronary angiography as part of a pretransplant evaluation. Twenty-four azotemic diabetics undergoing inpatient evaluation not including angiography for transplantation formed the control group. Serum creatinine measurements obtained at baseline and after radiocontrast exposure were compared in patients and control subjects. Risk factors for contrast nephropathy were evaluated in patients with a 25% or greater increase in serum creatinine.
Results:
Serum creatinine was significantly elevated 24 hours after radiocontrast exposure in patients (557 +/- 141 mumol/L versus 522 +/- 141 mumol/L, mean +/- SD; p less than 0.001) but not in controls. Seven patients required dialysis within 6 days of coronary angiography and two additional patients required dialysis within 14 days. Contrast nephropathy, defined as a serum creatinine increase of greater than 25% when measured 48 hours after radiocontrast exposure, occurred in 50% of patients and no controls. Univariate analysis of risk factors for contrast nephropathy revealed a significant association with dye quantity (p = 0.002), mean arterial pressure less than 100 mm Hg (p = 0.02), and ejection fraction less than 50% (p = 0.04). Stepwise logistic regression verified the independence of dye quantity and low mean arterial pressure but not low ejection fraction as risk factors for contrast nephropathy. Follow-up serum creatinine values were not significantly different in patients and control subjects.
Conclusions:
Azotemic patients with diabetes are at high risk of developing contrast nephropathy even when less than 100 mL of radiocontrast agent is used. The acute renal failure is reversible but precipitates the need for short-term dialysis in some patients. Radiocontrast quantity is an important risk factor not previously noted. The incidence of contrast nephropathy can be minimized by using less than 30 mL of radiocontrast agent.