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Kidney Week

Abstract: TH-PO076

Incidence and Prevention of Contrast-Induced Nephropathy in Percutaneous Coronary Intervention

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Garris, Rana R., St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Patel, Prem, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Tailor, Radhika, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Pal, Trina, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Laxina, Ian, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Camacho, Yudi, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Biggiani, Stephen, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Sourial, Mina, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Chandran, Chandra B., St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Abuarqoub, Ahmad H., St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Patel, Hiten, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
  • Shamoon, Fayez, St. Joseph's Health/NYMC, Nutley, New Jersey, United States
Background

Contrast induced nephropathy (CIN) has been reported in 20% of patients who undergo percutaneous coronary intervention (PCI). Contrast induces nephrotoxicity through direct tubule toxicity, capillary obstruction, vasoconstriction and hypoxia. Patients who have poor renal reserve with comorbidities are more susceptible, while the pleiotropic effects of statins may be nephroprotective. Prior studies have debated the role of contrast in the development of renal insufficiency. We hypothesize that while post-PCI acute kidney injury is multifactorial, the occurrence of CIN is likely understated. This is of clinical importance, because CIN is related to worse outcomes and longer hospital stays. Patient risk stratification can mitigate this risk.

Methods

Our study evaluates the incidence of CIN among 1521 patients at our hospital over 1 year. We used SAS 9.4 to perform logistic regression to assess the occurrence of CIN among patients with pre-PCI normal versus abnormal renal function (determined by GFR and Cr) in regards to underlying comorbidities. We also incorporated a CIN risk-calculator into our hospital EMR system and PCI practices.

Results

Our results showed that 15.3% of patients who underwent PCI developed CIN. Advanced age (OR 1.014, p = 0.02); race (blacks had OR 1.8, p = 0.01); underlying heart failure (OR 1.6 p = 0.004), especially among those with BNP > 400 (OR 4.5, p < 0.001) or EF < 40% (OR 1.47, p = 0.04); and diabetes (OR 2.0, p = 0.002) increased the probability of CIN. Patients with Cr > 1.2 were 3X more likely to get CIN (p < 0.001). GFR 30 – 60 and GFR < 30 increased the odds of CIN by 2.5 and 5 times, respectively (p < 0.01). By each unit decrease in hemoglobin, the odds of CIN increased by 5.5% (p = 0.002). Statin use reduced CIN by 42.9% (p = 0.001). Most notably, CIN also occurred in 9.1% of patients with normal baseline kidney function; among these patients, diabetes and age were the only contributory covariants.

Conclusion

Patients who undergo PCI are at significant risk of CIN. While baseline renal dysfunction and comorbidities are contributory, patients without these risk factors also developed CIN. Statins were renal-protective.