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Serum osmolarity as a potential predictor for contrast-induced nephropathy following elective coronary angiography

  • Nephrology - Original Paper
  • Published:
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Abstract

Background and objectives

Contrast-induced nephropathy (CIN) is a relatively common complication following primary coronary angiography (CAG) or percutaneous coronary intervention (PCI), especially in at-risk patients. The goal of this study is to evaluate the role of pre-procedural serum osmolarity as a risk factor for CIN in patients undergoing elective CAG for stable coronary artery disease (CAD).

Materials and methods

A total of 356 stable CAD patients scheduled to undergo CAG or PCI were included in this two-center study. Serum osmolarity was calculated on admission. CIN was defined according to the KDIGO criteria.

Results

There were 45 (12.6%) patients who developed CIN 48–72 h after CAG or PCI. CIN patients had a higher prevalence of diabetes (51.1% in those with CIN vs 24.4% in those without CIN, p < 0.001), higher serum glucose (129 mg/dL in those with CIN vs 108 mg/dL in those without CIN, p < 0.001), blood urea nitrogen (22.4 mg/dL in those with CIN vs 19.0 mg/dL in those without CIN, p = 0.01) and serum osmolarity (294.2 mOsm in those with CIN vs 290.1 mOsm in those without CIN, p < 0.001) levels, had received a higher dose of contrast (250 mL in those with CIN vs 200 mL in those without CIN, p = 0.03) but had lower hemoglobin (12.9 g/dL in those with CIN vs 13.6 g/dL in those without CIN, p = 0.04) level. In multivariate analysis, serum osmolarity [odds ratio (OR) 1.11; 95% confidence interval (CI) 1.04–1.18 for each mOsm/L increase; p = 0.001], diabetes (OR 2.43, 95% CI 1.26–4.71; p = 0.01), C-reactive protein (OR 1.04, 95% CI 1.01–1.08 for each mg/dL increase; p = 0.02) and contrast volume (OR 34.66, 95% CI 1.25–962.22 for each L increase; p = 0.04) remained as independent predictors of CIN. Serum sodium, glucose and blood urea nitrogen contributed to the excess serum osmolarity of CIN patients.

Conclusion

Serum osmolarity is a cheap and widely available marker that can reliably predict CIN after CAG or PCI. Future research should focus on determining a clinically optimal cutoff for serum osmolarity that would warrant preventive interventions. Furthermore, later research may investigate the role of serum osmolarity not only as a risk factor but also as a pathogenetic mechanism underlying CIN.

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Acknowledgements

MK gratefully acknowledges use of the services and facilities of the Koc University Research Center for Translational Medicine (KUTTAM), funded by the Presidency of Turkey, Presidency of Strategy and Budget. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Presidency of Strategy and Budget.

Funding

This study was not funded by any grant.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey

    Mehmet Kanbay

  2. Nephrology Clinic, Dialysis and Renal Transplant Center, ‘C.I. PARHON’ University Hospital, and ‘Grigore T. Popa’ University of Medicine, Iasi, Romania

    Dimitrie Siriopol & Adrian Covic

  3. Department of Medicine, Koc University School of Medicine, Istanbul, Turkey

    Elif Ozdogan & Lale A. Ertuglu

  4. Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey

    Baris Afsar

  5. Department of Obstetrics and Gynecology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania

    Mihaela Grigore

  6. Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, USA

    Alan A. Sag

  7. Department of Cardiology, Toranomon Hospital, Tokyo, Japan

    Masanari Kuwabara

  8. Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Avd. Reyes Católicos 2, 28040, Madrid, Spain

    Miguel A. Lanaspa & Richard J. Johnson

  9. Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO, USA

    Alberto Ortiz

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  1. Mehmet Kanbay
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Correspondence to Mehmet Kanbay.

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Kanbay, M., Siriopol, D., Ozdogan, E. et al. Serum osmolarity as a potential predictor for contrast-induced nephropathy following elective coronary angiography. Int Urol Nephrol 52, 541–547 (2020). https://doi.org/10.1007/s11255-020-02391-4

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