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Risk scoring system for prediction of contrast-induced nephropathy in patients with pre-existing renal impairment
1Alexandra Hospital, Jurong General Health, 378 Alexandra Road, Singapore 159964. ericchong80@hotmail.com
Insights
Patients with impaired renal function undergoing percutaneous coronary intervention (PCI) face a high risk of contrast-induced nephropathy (CIN). A new risk model identifies predictors like age and anemia to forecast CIN occurrence.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Baseline renal impairment is a primary risk factor for contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI).
- Identifying additional risk factors in high-risk patients is crucial for predicting CIN.
- This study aimed to develop a predictive risk model for CIN in patients with pre-existing renal dysfunction.
Purpose of the Study:
- To identify additional risk factors for contrast-induced nephropathy (CIN) in patients with impaired renal function undergoing percutaneous coronary intervention (PCI).
- To develop a risk prediction model for CIN in this high-risk population.
Main Methods:
- A cohort of 770 patients with estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 undergoing PCI were analyzed.
- Patients received standard prophylactic saline hydration and N-acetylcysteine.
- CIN was defined as a >25% increase in serum creatinine within 48 hours post-PCI.
Main Results:
- Despite prophylaxis, CIN occurred in 11.4% of patients.
- Key predictors of CIN included older age, anemia (hemoglobin < 11 mg/dL), post-procedure creatinine kinase rise, systolic hypotension (< 100 mmHg), and higher contrast volume.
- CIN incidence increased significantly with worsening renal failure (eGFR < 20 ml/min/1.73 m2 showed 40.8% incidence).
Conclusions:
- Patients with renal impairment undergoing PCI remain at high risk for CIN, even with standard prophylaxis.
- A predictive risk model incorporating identified clinical factors can estimate CIN likelihood.
- The model allows for risk stratification, with potential CIN incidence ranging from 2% to over 50% based on individual risk profiles.
Introduction:
Baseline renal impairment is the most recognised risk factor for development of contrast-induced nephropathy (CIN) post percutaneous coronary intervention (PCI). We examined the additional risk factors in this high-risk group and aimed to develop a risk model for prediction of CIN.
Methods:
A cohort of 770 consecutive patients with existing impaired renal function (estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2), who received routine prophylactic saline hydration and oral N-acetylcysteine treatment while undergoing PCI between May 2005 to October 2008 in our centre, were enrolled. The study endpoint, CIN, was defined as > 25% increase from baseline creatinine within 48 hours post PCI.
Results:
Despite routine prophylaxis, CIN occurred in 11.4% of the patients. Important clinical predictors for CIN were age (odds ratio [OR] 1.59, 95% confidence level [CI] 1.0-2.52, p = 0.049), anaemia with haemoglobin < 11 mg/dL (OR 2.26, 95% CI 1.41-3.61, p = 0.001), post-procedure creatinine kinase rise (OR 1.12, 95% CI 1.07-1.16 for every 500 u/L increase, p < 0.001), systolic hypotension with blood pressure < 100 mmHg (OR 2.53, 95% CI 1.16-5.52, p = 0.016) and higher contrast volume. The incidence of CIN was significantly higher in patients with more severe renal failure (6.3%, 17.4% and 40.8% when eGFR was 40-60, 20-40 and < 20 ml/min/1.73 m2 respectively, p < 0.001). A prediction model was developed based on these findings. The incidence of CIN could vary from 2% to > 50% depending on these additional risk profiles.
Conclusion:
Patients with impaired renal function undergoing PCI are at high risk of developing CIN despite traditional prophylaxis. A model of risk prediction could be used to predict its occurrence.
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