Ikram Ullah, Farooq Ahmad, Muhammad Israr, Iqtidar Uddin, Mehmood Ul Hassan


Background: Contrast induced nephropathy is a common form of acquired acute renal failure after coronary angiography and percutaneous coronary intervention (PCI) and this is associated with prolonge hospital stay and worse outcome. This study was conducted to find various risk factors responsible for contrast induced nephropathy in patients undergoing PCI.
Material & Methods: This was cross-sectional study performed at Hayatabad Medical Complex, Peshawar, Pakistan from July 01, 2014 to Dec. 31, 2014. Contrast induced nephropathy (CIN) is defined as increase in serum creatinine of ≥25% from baseline value and/ or an absolute increase of ≥0.5 mg/dl in serum creatinine from baseline. To identify independent characteristics associated with CIN, multivariable logistic regression analysis was used through SPSS version 15. Results of this model were presented as Odds Ratio (OR). P value was calculated to see the significance of various risk factors.
Results: We studied 177 patients with mean age of 60 ± 5.71 years. Overall frequency of CIN was found to be 10 %. CIN was found in 18.6 % of patients in older age group as compared to 5.9 % in younger age group (p-value =0.01, OR =3.6). In diabetic patients CIN was found in 19.2 % patients as compared to 6.4 % in non-diabetics (p-value =0.05, OR= 3.4). CIN was found in 40 % patients who were having baseline creatinine ≥ 1.5 mg/dl as compared to 8.4 % in <1.5mg/dl creatinine group (p-value =0.01, OR=7.2). In higher contrast dose (>150 ml), CIN frequency was significantly higher (13.7% vs. 3.3 %) and it was also significantly higher in patients with heart failure (33.3 % vs. 8 %).
Conclusion: Diabetes mellitus, heart failure, chronic kidney disease, advanced age and higher contrast dose were significantly associated with contrast induced nephropathy.


Percutaneous Coronary Intervention; Contrast Induced Nephropathy; Diabetes Mellitus; Chronic Kidney Disease; Coronary Artery Bypass Grafting; Acute Kidney Injury.

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Ix JH, Shlipak MG, Liu HH, Schiller NB, Whooley MA. Association between renal insufficiency and inducible ischemia in patients with coronary artery disease: the heart and soul study. Journal of the American Society of Nephrology 2003; 14:3233-8.

Anavekar NS, McMurray JVV, Velazquez EJ. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004; 351 :1285-95.

Ohtake T, Kobayashi S, Moriya H. High prevalence of occult coronary artery stenosis in patients with chronic kidney disease at the initiation of renal replacement therapy: an angiographic examination. Clin J Am Soc Nephrol 2005;16:1141-8.

Levin A. Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Seminars in Dialysis 2003 ;16:101–5.

Collins AJ. Cardiovascular mortality in end-stage renal disease. Am J Med Sci 2003;325:163-7.

Go SA, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-70

Park K, Chung WU, Seo JB, Kim SH, Zo JH, Kim MA, et al. The prevention of contrast induced nephropathy by sarpogrelate in patients with chronic kidney disease: A study protocol for a prospective randomized controlled clinical trial. Trials 2010;11:122.

Wood SP. Contrast induced nephropathy in critical care. Crit Care Nurse 2012;32:15- 24

McCullough PA. Acute kidney injury with iodinated contrast. Crit Care Med 2008;36:204-11

Riley RF, Don CW, Powell W, Maynard C, Dean LS. Trends in Coronary Revascularization in the United States From 2001 to 2009. Circulation: Cardiovascular Quality and Outcomes 2011; 4:193-7.

McCullough PA. Contrast-Induced Acute Kidney Injury. J Am Coll Cardiol 2008; 51:1419-28.

Lindsay J, Apple S, Pinnow EE. Percutaneous coronary intervention-associated nephropathy foreshadows increased risk of late adverse events in patients with normal baseline serum creatinine. Catheterization and Cardiovascular Interventions 2003; 59:338-343.

Dangas G, Iakovou I, Nikolsky E. Contrast-Induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 2005;95:13-19.

Marenzi G, Lauri G, Assanelli E. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 2004;44:1780-5.

Barrett BJ. Contrast nephrotoxicity. Journal of the American Society of Nephrology 1994;5:125-37.

Subramanian S, Tumlin J, Bapat B, Zyczynski T. Economic burden of contrast induced nephropathy: implications for prevention strategies. J Med Economics 2007;10:119-34.

Mehran R, Aymong ED, Nikolsky E. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004;44:1393-9.

Bartholomew BA, Harjai KJ, Dukkipati S. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. The Am J Cardiol 2004;93:1515-9.

Weisbord SD, Mor MK, Resnick AL, Hartwig KC, Palevsky PM, Fine MJ. Incidence and Outcomes of Contrast-Induced AKI Following Computed Tomography.Clinical J Am Soc Nephrol 2008; 3:1274-81.

Chen SL, Zhang J, Yei F. Clinical outcomes of contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: a prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine. Int J Cardiol 2008;126:407-13.

Dangas G, Iakovou I, Nikolsky E. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 2005;95:13-9.

Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME et al. Contemporary Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions Insights From the NCDR Cath-PCI Registry. J Am Coll Cardiol Intv 2014;7:1-9.

Takagi T, Stankovich G, Finci L. Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery. Circulation 2002;106:698-702.

Mekan SF , Rabbani MA, Azhar-Uddin M, Ali SS. Radiocontrast nephropathy: is it dose related or not?. J Pak Med Association 2004;54:372-4.

Kane G C, Doyle B J, Lerman A, Barsness G W, Best P J, Rihal C S. Ultra-low contrast volumes reduce rates of contrast-induced nephropathy in patients with chronic kidney disease undergoing coronary angiography. J Am Coll Cardiol 2008;51:89-90.

Lunetta SM, Macaione M,Fonte G, Milana G, Corrado E, Bonura B et al. Risk factors for contrast induced nephropathy: A study among Italian patients. Indian Heart J 2012;64:484-91.

Rihal CS, Textor SC, Grill DE. Incidence and Prognostic Importance ofAcute Renal Failure After Percutaneous Coronary Intervention. Circulation 2002;105:2259-66.


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