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Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease

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Abstract

Objectives

Contrast-induced nephropathy (CIN) has not been systematically studied in high-risk patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Methods

We prospectively observed 515 consecutive patients with CKD undergoing PCI. Patients were divided into three groups: patients who underwent attempted PCI for CTO (group A, n = 85), patients who did not receive PCI for CTO (group B, n = 45) and patients without CTO (group C, n = 385).

Results

CIN developed in 55 patients (10.68 %). Group A patients received a larger CM dose than group B or group C (p = 0.024). The intravenous hydration volume, age and CIN Mehran score were not significantly different between the three groups. The incidence of CIN was 9.4 % for group A, 6.7 % for group B and 11.4 % for group C (p = 0.344). In-hospital mortality and required renal replacement therapy (p = 0.325) were not significantly different between the groups. Multivariate analysis showed that after adjusting for potential confounding factors, the odds ratio for CIN was 1.03 (p = 0.944) for group A and 0.64 for group B (p = 0.489) compared to group C.

Conclusions

Attempts to achieve recanalization of CTO in patients with CKD might not increase the risk of CIN if appropriate preventative measures are taken.

Key Points

• Contrast-induced nephropathy can increase morbidity and mortality

• Chronic kidney disease patients are at the greatest risk of CIN

• Patients with CKD undergoing CTO-PCI are common

• Incidence of CIN has not been reported in CKD patients

• CTO-PCI in CKD patients might not increase the risk of CIN

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Abbreviations

AMI:

acute myocardial infarction

CABG:

coronary artery bypass graft

CIN:

contrast-induced nephropathy

CKD:

chronic kidney disease

CM:

contrast media

CTO:

chronic total occlusion

eGFR:

estimated glomerular filtrate rate

LVEF:

left ventricular ejection fractions

PCI:

percutaneous coronary intervention

SCr:

serum creatinine

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Acknowledgments

Ning Tan, Ji-yan Chen, Yong Liu, Yuan-hui Liu conceived and designed the study, analysed and interpreted the data. Yong Liu and Yuan-hui Liu drafted the manuscript and Ying-ling Zhou, Jian-fang Luo, Dan-qing Yu, Li-wen Li, Hua-long Li, Piao-Ye and Peng Ran critically revised the manuscript for intellectual content. Ning Tan approved the final version of the manuscript. All of the authors were involved the manuscript preparation. We appreciate the efforts of our statistical consultant, Prof. Ping-Yan Chen, MS, of the Department of Biostatistics, Southern Medical University, China.

The scientific guarantor of this publication is Ning Tan. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study was supported by a grant from the National Natural Science Foundation of China (grant no. 81270286) and Guangdong Cardiovascular Institute, Guangdong Provincial Cardiovascular Clinical Medicine Research Fund (grant no: 2009X41). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Moreover, the work was not funded by any industry sponsors. Prof. Ping-Yan Chen kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was obtained from all patients in this study.

Methodology: prospective, observational, performed at one institution.

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Authors and Affiliations

  1. Southern Medical University, Guangzhou, 510515, Guangdong, China

    Yuan-hui Liu & Ning Tan

  2. Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, Guangdong, China

    Yuan-hui Liu, Yong Liu, Ning Tan, Ji-yan Chen, Ying-ling Zhou, Jian-fang Luo, Dan-qing Yu, Li-wen Li, Hua-long Li, Piao Ye & Peng Ran

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  1. Yuan-hui Liu
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Corresponding author

Correspondence to Ning Tan.

Additional information

The first two co-authors contributed equally to this work. Ning Tan and Ji-yan Chen were considered equally as corresponding authors.

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Liu, Yh., Liu, Y., Tan, N. et al. Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease. Eur Radiol 25, 2274–2281 (2015). https://doi.org/10.1007/s00330-014-3360-1

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  • DOI: https://doi.org/10.1007/s00330-014-3360-1

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