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Published on: April 18, 2013
Impact of Contrast-Induced Nephropathy on Long-Term Renal Function after Coronary Angiography and Contrast-Enhanced
Hidekazu Moriya1, Yasuhiro Mochida1, Kunihiro Ishioka1
1Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan.
Insights
Contrast-induced nephropathy (CIN) does not worsen long-term kidney function after procedures. Pre-existing renal dysfunction, even severe, does not increase the risk of developing CIN. This finding impacts patient risk assessment for contrast procedures.
Area of Science:
- Nephrology
- Radiology
- Cardiology
Background:
- Contrast-induced nephropathy (CIN) is a concern after contrast procedures.
- The prognostic impact of CIN on long-term renal function and vice versa is unclear.
Purpose of the Study:
- To evaluate CIN occurrence in patients with pre-existing renal dysfunction.
- To investigate the long-term effects of worsening renal function post-contrast procedures.
- To analyze prognostic factors for worsening renal function.
Main Methods:
- Prospective cohort study of at-risk patients (eGFR <60 mL/min/1.73 m² for coronary angiography, <45 mL/min/1.73 m² for CT).
- CIN defined as serum creatinine increase >0.5 mg/dL or 25% within 72 hours.
- Primary endpoint: serum Cr doubling or dialysis induction within 2 years.
Main Results:
- 19/410 patients developed CIN.
- 38/410 patients experienced worsened renal function.
- CIN was not associated with 2-year worsening renal function.
- No difference in CIN occurrence based on baseline eGFR (≥30 vs <30 mL/min/1.73 m²).
Conclusions:
- CIN is not a prognostic risk factor for chronic kidney disease progression post-contrast procedures.
- Pre-existing renal dysfunction, including severe cases (eGFR <30), does not increase CIN risk.
Background:
It remains unclear whether contrast-induced nephropathy (CIN) has a prognostic impact on subsequent renal dysfunction and whether deteriorating renal function is a risk factor for CIN. This study aimed to evaluate the occurrence of CIN in patients with pre-existing renal dysfunction and investigate the long-term effects of worsening renal function after coronary angiography or contrast-enhanced computed tomography (CT). The prognostic factors of worsening renal dysfunction were also analyzed.
Methods:
This was a prospective cohort study of patients at risk for CIN, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 on coronary angiography or eGFR <45 mL/min/1.73 m2 on contrast-enhanced CT. Serum creatinine levels and the 2-year prognosis were evaluated. CIN was defined as an increase in serum creatinine level by more than 0.5 mg/dL or a 25% increase from the previous value within 72 hours after contrast administration. The primary endpoint was the proportion of patients who had serum Cr doubling or induction of dialysis within 2 years according to CIN occurrence.
Results:
Of the 410 patients, 19 patients developed CIN (8/142 patients on coronary angiography and 11/268 patients on contrast-enhanced CT), and 38 patients had worsened renal function (21/142 patients on coronary angiography and 17/268 patients on contrast-enhanced CT). CIN was not associated with worsening renal function at 2 years. Analysis by renal function at the time of coronary angiography or contrast-enhanced CT (i.e., eGFR ≥30 ml/min/1.73 m2 and eGFR ≤1.73 m2) found no between-group difference in the occurrence of CIN.
Conclusions:
CIN is not a prognostic risk factor for the long-term of chronic kidney disease after coronary angiography or contrast-enhanced CT. Pre-existing renal dysfunction is also not a risk factor for CIN, even if the eGFR is <30 ml/min/1.73 m2.
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