Prediction of contrast-induced nephropathy by the serum creatinine level on the day following cardiac catheterization

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• 作者：Makoto Watanabe ; MD ; PhD^a ; Yoshihiko Saito ; MD ; PhD ; FJCC^a ; ^{yssaito@naramed-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kazutaka Aonuma ; MD ; PhD ; FJCC^b ; Atsushi Hirayama ; MD ; PhD ; FJCC^c ; Nagara Tamaki ; MD ; PhD ; FJCC^d ; Hiroyuki Tsutsui ; MD ; PhD ; FJCC^e ; Toyoaki Murohara ; MD ; PhD^f ; Hisao Ogawa ; MD ; PhD ; FJCC^g ; Takashi Akasaka ; MD ; PhD ; FJCC^h ; Michihiro Yoshimura ; MD ; PhD ; FJCCⁱ ; Akira Sato ; MD ; PhD ; FJCC^b ; Tadateru Takayama ; MD ; PhD^c ; Mamoru Sakakibara ; MD ; PhD^e ; Susumu Suzuki ; MD ; PhD^f ; Kenichi Ishigami ; MD ; PhD^j ; Kenji Onoue ; MD ; PhD^a ; on behalf of the CINC-J study investigators
• 关键词：Contrast-induced nephropathy ; Change in serum creatinine level ; Change in estimated glomerular filtration rate ; Prediction of contrast-induced nephropathy
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：68
• 期：5
• 页码：412-418
• 全文大小：1033 K

文摘

The majority of patients who undergo coronary arteriography are discharged from the hospital on the day of the procedure or on the following day. The aim of this study is to investigate whether the change in serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) on the day following cardiac catheterization can predict the development of contrast-induced nephropathy (CIN).

Methods

This is a multicenter prospective observational study, which consists of 860 patients who underwent cardiac catheterization. We measured SCr and eGFR before cardiac catheterization, on the following day, and 48–72 h post-procedure. Definition of CIN is changes in SCr ≥0.5 mg/dL or ≥25% from baseline 48–72 h after contrast exposure.

Results

CIN occurred in 40 patients. SCr levels significantly increased from a baseline of 1.55 ± 1.08 mg/dL to 1.79 ± 1.26 mg/dL on the following day in patients with CIN (p < 0.0001), but significantly decreased from a baseline of 1.21 ± 0.65 mg/dL to 1.18 ± 0.61 mg/dL on the following day in those without CIN (p < 0.0001). eGFR significantly decreased from a baseline of 47.3 ± 28.3 mL/min/1.73 m² to 40.6 ± 26.7 mL/min/1.73 m² on the following day in patients with CIN (p < 0.0001), but significantly increased from a baseline of 53.1 ± 22.0 mg/dL to 53.6 ± 21.2 mg/dL on the following day in those without CIN (p = 0.0236). Receiver operating characteristic curve analysis indicated that SCr change ≥0.1 mg/dL [area under the curve (AUC) = 0.852, sensitivity 72.5%, specificity 86.1%] and eGFR change ≤−1.1 mL/min/1.73 m² (AUC = 0.789, sensitivity 85.0%, specificity 64.9%) were the best cut-off values for predicting CIN. Multivariate logistic regression showed that a change in SCr ≥0.1 mg/dL [odds ratio (OR), 29.3; 95% confidence interval (CI), 10.8–96.2] and change in eGFR ≤−1.1 mL/min/1.73 m² (OR, 69.7; 95% CI, 13.3–952) were powerful independent predictors of CIN.

Conclusions

Changes in SCr and eGFR on the day following cardiac catheterization predict the development of CIN.