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Clinical Implications of Contrast-Induced Nephropathy in Patients Without Baseline Renal Dysfunction Undergoing
Shi-Qun Chen1, Yong Liu2, Brendan Smyth3
1Guangdong General Hospital Zhuhai Hospital, Zhuhai Golden Bay Center Hospital, Zhuhai, 519040, China.
Insights
Contrast-induced nephropathy (CIN) definition impacts incidence. Absolute CIN, though less common, significantly increases long-term mortality risk in patients undergoing coronary angiography, underscoring the need for further research.
Area of Science:
- Nephrology
- Cardiology
- Medical Diagnostics
Background:
- Clinical significance of various contrast-induced nephropathy (CIN) definitions remains unclear in patients without pre-existing kidney issues.
- Assessing long-term mortality risk associated with CIN requires standardized definitions.
Purpose of the Study:
- To evaluate the long-term mortality risk associated with different definitions of CIN in patients without baseline renal dysfunction undergoing coronary angiography.
- To compare the incidence and prognostic implications of absolute versus relative CIN.
Main Methods:
- A single-center study included consecutive patients with estimated glomerular filtration rate (eGFR) ≥60ml/min/1.73m² undergoing coronary angiography or percutaneous coronary intervention (PCI).
- CIN was defined by absolute (serum creatinine [SCr] increase ≥0.3mg/dl) and relative (SCr increase ≥25%) criteria within 72 hours.
- Long-term mortality was assessed over a median follow-up of 2.3 years.
Main Results:
- Incidence rates for mild to severe CIN were 11.3% (relative) and 4.4% (absolute) among 2,823 patients.
- Absolute CIN was linked to a significantly higher adjusted hazard ratio for all-cause mortality (3.31; p<0.0001) compared to relative CIN (1.92; p=0.024).
- Increased mortality risk correlated with CIN severity, irrespective of the definition used.
Conclusions:
- CIN incidence varies widely based on definition in patients without baseline renal dysfunction.
- Absolute CIN is less frequent but carries a more substantial mortality risk than relative CIN.
- CIN, by any definition, is associated with a markedly elevated long-term mortality risk, warranting multicenter validation.
Background:
The clinical implications of different definitions of contrast-induced nephropathy (CIN) in patients without baseline renal dysfunction are not well defined.
Methods:
Consecutive patients at a single centre without baseline renal dysfunction (estimated glomerular filtration rate, eGFR≥60ml/min/1.73m2) undergoing coronary angiography or percutaneous coronary intervention (PCI), were systematically evaluated for long-term risk of mortality following CIN using two broad definitions: an absolute increase from baseline in serum creatinine (SCr) ≥0.3mg/dl (mild to severe absolute CIN) and a relative increase from baseline of 25% (mild to severe relative CIN) within 72hours.
Result:
Of 2,823 subjects alive before discharge following coronary angiography there were 320 episodes of mild to severe relative CIN (11.3%) and 125 of mild to severe absolute CIN (4.4%). During a median follow-up of 2.3years, 73 patients (3.2%) died. After adjustment for confounders, mild to severe absolute CIN was associated with an adjusted hazard ratio (HR) (95% confidence interval) for all-cause mortality of 3.31 (1.74-6.30) (p<0.0001) and relative CIN with an adjusted HR of 1.92 (1.09, 3.38) (p=0.024). The risk of mortality rose with severity of CIN. Two commonly used definitions of CIN combining absolute and relative terms (increase ≥ 0.3mg/dl or 50%, and ≥ 0.5mg/dl or 25% from the baseline) confirmed these results.
Conclusion:
Among patients without baseline renal dysfunction undergoing coronary angiography, the incidence of CIN can range widely depending on definition. Absolute CIN is less common than relative CIN. Regardless of definition, CIN is associated with a markedly increased risk of long-term mortality. This finding requires confirmation in multicentre studies.
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