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Risk factors for hemodialysis and mortality in patients with contrast-induced nephropathy
Hoang M Lai1, Wilbert S Aronow, Savneek S Chugh
1Department of Medicine, Division of Cardiology and Division of Nephrology, New York Medical College/Westchester Medical Center, Valhalla, NY.
Insights
This study identified risk factors for mortality and hemodialysis in patients with contrast-induced nephropathy (CIN) after cardiac catheterization. Catecholamine use and circulatory failure increased mortality, while anemia and circulatory failure worsened renal failure. Calcium channel blockers reduced mortality, and N-acetylcysteine use and smoking reduced renal failure.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Contrast-induced nephropathy (CIN) is a significant complication following cardiac catheterization.
- Identifying risk factors for CIN-related mortality and renal failure is crucial for patient management.
Purpose of the Study:
- To determine independent risk factors for mortality and the need for hemodialysis in patients who develop CIN post-cardiac catheterization.
- To explore factors that may reduce mortality and renal failure in this patient population.
Main Methods:
- Retrospective chart review of 13,742 patients undergoing cardiac catheterization.
- Screening for CIN based on serum creatinine changes within 48 hours of the procedure.
- Logistic regression analysis to identify independent risk factors for mortality and hemodialysis.
Main Results:
- Of 80 CIN patients, 23% died and 28% required hemodialysis.
- Independent risk factors for mortality included catecholamine use, circulatory failure with lactic acidosis, and renal failure requiring hemodialysis.
- Independent risk factors for renal failure requiring hemodialysis included anemia and circulatory failure with lactic acidosis.
- Calcium channel blocker use was associated with reduced mortality, while N-acetylcysteine use and smoking were associated with reduced renal failure.
Conclusions:
- Catecholamine use, circulatory failure with lactic acidosis, and renal failure requiring hemodialysis are significant risk factors for mortality in CIN patients.
- Anemia and circulatory failure with lactic acidosis are significant risk factors for developing renal failure requiring hemodialysis.
- Calcium channel blockers may reduce mortality, and N-acetylcysteine and smoking may reduce renal failure in patients with CIN.
Abstract:
The purpose of this study was to identify risk factors for renal failure requiring hemodialysis and mortality in patients who developed contrast-induced nephropathy (CIN) after cardiac catheterization. Out of 13,742 patients who received cardiac catheterization at Westchester Medical Center/New York Medical College from 2005 to 2008, 268 patients (2%) with a discharge diagnosis of renal failure were screened for CIN. CIN was defined as either a >25% increase of the serum creatinine or an absolute increase in serum creatinine of 0.5 mg/dL within the first 48 hours of the procedure. Chart reviews were performed on 80 patients (1%) who met the criteria for CIN. The 80 patients in the study included 46 men and 34 women, mean age 69 ± 14 years. Of the 80 patients, 18 patients (23%) died, and 22 patients (28%) developed renal failure requiring hemodialysis. Stepwise logistic regression analysis showed that independent risk factors for mortality were the use of calcium channel blockers [odds ratio = 0.0025, 95% confidence interval (CI), 0.0001-0.1210, P < 0.01], catecholamine use (odds ratio = 71.2177, 95% CI, 4.2153-1203, P < 0.01), circulatory failure with lactic acidosis (odds ratio = 32.1405, 95% CI, 2.6331-392, P < 0.01), and renal failure requiring hemodialysis (odds ratio = 17.0376, 95% CI, 1.2344-235, P < 0.05). Significant independent risk factors for renal failure requiring hemodialysis were smoking (odds ratio = 0.06, 95% CI, 0.0045-0.8080, P < 0.05), N-acetylcysteine use (odds ratio = 0.08, 95% CI, 0.0148-0.4179, P < 0.01), anemia (odds ratio = 11.32, 95% CI, 2.57-50, P < 0.01), and circulatory failure with lactic acidosis (odds ratio = 9.76, 95% CI, 2.37-40, P < 0.01). Our data showed that risk factors for mortality in patients with CIN were catecholamine use, circulatory failure with lactic acidosis, and renal failure requiring hemodialysis. Risk factor for reducing mortality in patients with CIN was calcium channel blocker use. Significant risk factors for renal failure requiring hemodialysis were anemia, and circulatory failure with lactic acidosis. Risk factors for reducing renal failure requiring hemodialysis were N-acetylcysteine use and smoking.
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