Incidence, Risk Factors, and Outcomes of Contrast Associated Nephropathy following Percutaneous Coronary Intervention

Abstract

Introduction: Contrast-associated acute kidney injury (CA-AKI) is a prevalent but underdiagnosed complication of percutaneous coronary intervention (PCI) that is associated with increased inhospital morbidity and mortality. Aims and Objectives: The aims and objectives were to study the incidence, risk factors, and outcome of CA-KI following PCI. Materials and Methods: This was a single-center prospective observational study. Five hundred patients who were admitted in ward and medical intensive care unit with chronic stable angina and acute coronary syndrome (unstable angina, non-ST-elevation myocardial infarction [STEMI], and STEMI) for PCI (intracoronary stent implantation) were included in the present study. All baseline demographic and clinical characteristics including pre- and postprocedure kidney function test (24 h, 48 h) were noted. Hospital stay, need for dialysis, and mortality were recorded. Results: In this study, 500 patients were enrolled. The mean age of presentation was 61.83 ± 13.17 years. Three hundred and sixty-six patients (73.2%) were male. Of 500 patients, 52 (10.4%) patients developed AKI. AKI was significantly higher in those with diabetes (27.2% vs. 5.4% P < 0.001), heart failure (23.1% vs. 6.5% P < 0.001), left ventricular (LV) dysfunction (21.6% vs. 6.3% P < 0.001), peripheral vascular disease (24.5% vs. 8.9% P = 0.002), hypotension (42.6% vs. 5.2% P < 0.001), creatinine >1.2 (18.5% vs. 5.9% P < 0.001), lower creatinine clearance < 60 (25.4% vs. 5.8% P < 0.001), higher procedural time >60 min (20.2% vs. 7.3% P < 0.001), and higher contrast volume (302.7 ± 37.83 mL in AKI patients vs. and 173.2 ± 23.61 mL in no AKI patients P < 0.001). Multivariate logistic regression analysis showed Type 2 diabetes mellitus, heart failure, LV dysfunction, creatinine clearance <60, and contrast volume more than 270 mL to be significantly associated with the incidence of CA-AKI. AKI patients had significantly prolonged hospital stay as compared to those without AKI (9.2 ± 2.73 vs. 4.7 ± 1.79 days P < 0.001). Dialysis was required only in one (1.9%) patient. AKI patients had higher in hospital mortality as compared to non-AKI group (3 [5.8%] vs. 2 [0.4%] P = 0.004). Conclusion: The incidence of AKI after PCI in our study was 10%. Patients having diabetes, heart failure, LV dysfunction, estimated creatinine clearance, and higher contrast volume were found to be at highest risk. Appropriate preventive measures should be taken in these high-risk patients to avoid adverse outcomes associated with contrast-induced nephropathy.