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A comparison of definitions of contrast-induced nephropathy in patients with normal serum creatinine

Mohammad Reza Khatami1, Nasrin Nikravan, Mojtaba Salari-Far

  • 1Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|January 21, 2016
PubMed

Insights

Contrast-induced nephropathy (CIN) is a common cause of kidney injury. In patients with normal baseline creatinine, an absolute increase in serum creatinine may be a more accurate indicator of CIN than relative changes or GFR.

Area of Science:

  • Nephrology
  • Cardiology
  • Radiology

Background:

  • Contrast-induced nephropathy (CIN) is a significant cause of hospital-acquired acute kidney injury.
  • CIN prevalence varies widely (0-50%) based on patient factors, procedures, and diagnostic definitions.
  • Accurate CIN diagnosis is crucial, especially in patients with normal baseline serum creatinine.

Purpose of the Study:

  • To identify the most reliable diagnostic indicator for CIN in patients presenting with normal serum creatinine levels.
  • To compare the diagnostic performance of different CIN definitions in this specific patient cohort.

Main Methods:

  • Prospective study of 206 patients with normal serum creatinine undergoing coronary angiography/angioplasty.
  • Measurement of serum creatinine and estimated glomerular filtration rate (eGFR) pre-procedure and on days 2 and 5 post-contrast.
  • Comparison of CIN incidence using three definitions: 25% serum creatinine increase, 25% eGFR decrease, and absolute 0.5 mg/dL serum creatinine increase.

Main Results:

  • CIN prevalence was 30% (25% creatinine increase), 23% (25% eGFR decrease, P<0.012), and 3.8% (0.5 mg/dL creatinine increase, P<0.0001).
  • Most CIN cases, by various definitions, had serum creatinine levels remaining within the normal range.
  • An absolute increase in serum creatinine demonstrated a higher prevalence of CIN compared to relative changes or eGFR decrease.

Conclusions:

  • The definition of CIN significantly impacts its reported prevalence.
  • In patients with normal baseline serum creatinine, an absolute increase in serum creatinine may offer a more accurate assessment of CIN incidence.
  • Further research may refine CIN diagnostic criteria for improved clinical management.

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