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An uninvestigated risk factor for contrast-induced nephropathy in chronic kidney disease: proteinuria
Serhan Piskinpasa1, Bulent Altun, Hadim Akoglu
1Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey. svppasa@yahoo.com
Insights
Proteinuria is a significant risk factor for contrast-induced nephropathy (CIN) in patients with chronic kidney disease. This study identified proteinuria of 1 g/day or more as a key predictor of CIN development.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Contrast-induced nephropathy (CIN) is a common cause of acute kidney injury in hospitalized patients.
- The increasing use of contrast media necessitates understanding risk factors for CIN.
Purpose of the Study:
- To investigate proteinuria as a potential risk factor for CIN in patients with chronic kidney disease.
Main Methods:
- Prospective study of 70 hospitalized patients with chronic kidney disease and proteinuria/eGFR <60 mL/min/1.73 m2.
- Patients received acetylcysteine and intravenous saline prophylaxis.
- CIN defined as a 25% increase in serum creatinine or 0.5 mg/dL increase at 72 hours post-contrast.
Main Results:
- CIN developed in 37.1% of patients.
- Significant correlations with CIN included advanced age, diabetes, heart failure, anemia, baseline sCr >1.5 mg/dL, baseline eGFR <60 mL/min/1.73 m2, proteinuria ≥1 g/day, hypoalbuminemia, and contrast volume ≥100 mL.
- Patients with proteinuria ≥1 g/day had significantly higher CIN rates (p = 0.009).
Conclusions:
- Proteinuria may represent a novel risk factor for CIN in chronic kidney disease patients.
- Identifying and managing proteinuria is crucial for preventing CIN.
Background:
Contrast-induced nephropathy (CIN) is one of the most frequent causes of acute renal failure in hospitalized patients with the incremental use of contrast media. We aimed to investigate whether proteinuria may act as a risk factor for CIN in patients with chronic kidney disease.
Methods:
Seventy hospitalized patients (37 men, 33 women) with chronic kidney disease, proteinuria, and/or estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2, who were exposed to contrast media were investigated prospectively. Thirty patients were diabetic. All patients received prophylaxis against CIN with acetylcysteine and 0.9% intravenous saline. CIN is defined as either a 25% higher increase in serum creatinine (sCr) from the baseline levels or a 0.5 mg/dL increase in sCr at 72 h after contrast media exposure.
Results:
CIN was detected in 26 (37.1%) patients. Advanced age, diabetes, heart failure, anemia, baseline sCr of >1.5 mg/dL, baseline eGFR of <60 mL/min/1.73 m(2), proteinuria of ≥1 g/day, hypoalbuminemia, and the volume of contrast media of ≥100 mL correlated significantly with CIN. The frequency of CIN was significantly higher in patients with proteinuria of ≥1 g/day compared to patients with proteinuria of <1 g/day (p = 0.009).
Conclusion:
Proteinuria may be a new risk factor for the development of CIN in patients with chronic kidney disease.
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