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Published on: August 28, 2018
Incidence of persistent renal dysfunction and long-term survival after coronary computed tomography angiography
Hamza Sunman1, Mustafa Arıcı2, Serkan Asil3
1Department of Cardiology, Health Science University, Etlik City Hospital, Ankara, Türkiye.
Insights
Contrast-induced nephropathy (CIN) after coronary computed tomography angiography (CTA) can lead to persistent renal dysfunction. CIN is the primary risk factor, and both CIN and renal dysfunction increase long-term mortality risk.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Contrast exposure can cause permanent renal impairment.
- Long-term data on coronary computed tomography angiography (CTA) impact on renal dysfunction is limited.
- Study examines incidence and long-term outcomes of persistent renal dysfunction post-coronary CTA.
Purpose of the Study:
- To investigate the incidence of persistent renal dysfunction after coronary CTA.
- To identify risk factors for persistent renal dysfunction post-coronary CTA.
- To assess the long-term outcomes, including mortality, associated with persistent renal dysfunction and contrast-induced nephropathy (CIN).
Main Methods:
- Included 2054 patients with pre- and post-coronary CTA creatinine measurements.
- Defined contrast-induced nephropathy (CIN) as a serum creatinine increase of ≥0.5mg/dl or ≥25% from baseline.
- Defined persistent renal dysfunction as sustained creatinine increase ≥6 months post-coronary CTA.
Main Results:
- Incidence of CIN was 1.0%; 1.9% of patients had persistent renal dysfunction at a median 2.5-year follow-up.
- Mortality rate was 2.0%, with 0.2% requiring permanent dialysis.
- Independent predictors of persistent renal dysfunction included age, diabetes, baseline renal function, and CIN occurrence.
- CIN and persistent renal dysfunction independently predicted long-term mortality.
Conclusions:
- Persistent renal dysfunction occurred in 1.9% of patients post-coronary CTA.
- Contrast-induced nephropathy (CIN) was the most significant risk factor for persistent renal dysfunction.
- Both CIN and persistent renal dysfunction are associated with increased long-term mortality.
Background:
Renal impairment following contrast exposure can sometimes become permanent, and data on the long-term impact of coronary computed tomography angiography (CTA) on renal dysfunction are limited. We aimed to examine the incidence and long-term outcome of persistent renal dysfunction after coronary CTA.
Methods:
We identified 3500 patients with creatinine levels measured before and six months after coronary CTA. A total of 2054 patients were included in the final analysis for contrast-induced nephropathy (CIN) diagnosis, defined as a serum creatinine increase of 0.5mg/dl or a relative increase of 25% from baseline. Persistent renal dysfunction was defined as an absolute increase of 0.5 mg/dl or a relative increase of 25% in creatinine levels after at least six months of follow-up.
Results:
The incidence of CIN was 1.0% and 40 (1.9%) patients had persistent renal dysfunction at median 2.5-year follow-up. Mortality rate was 2.0% (41 patients) and four patients (0.2%) required permanent dialysis during the same period. In multivariate regression analysis; age (odds ratio [OR]: 1.050, p = 0.027), diabetes (OR: 2.769, p = 0.004), baseline renal function (OR: 0.967, p = 0.003), and occurrence of CIN (OR: 7.760, p = 0.002) were identified as independent predictors of persistent renal dysfunction. Furthermore, occurrence of CIN and persistent renal dysfunction were found as independent predictors of long-term mortality.
Conclusion:
During follow-up after coronary CTA, the incidence of persistent renal dysfunction was 1.9%, and the occurrence of CIN was the most important risk factor. In addition, both CIN and persistent renal dysfunction were associated with long-term mortality.
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