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Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study.

Koo HM, Doh FM, Ko KI, Kim CH, Lee MJ, Oh HJ, Han SH, Kim BS, Yoo TH, Kang SW, Choi KH - BMC Nephrol (2013)

Bottom Line: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes.They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR).In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035].

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, College of Medicine, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul, Korea.

ABSTRACT

Background: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN.

Methods: We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA.

Results: CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E' in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E' values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E' was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001).

Conclusions: This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.

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Kaplan-Meier analysis for cumulative hazard of patient mortality. There was a tendency toward higher mortality in patients with diastolic dysfunction (E/E’ > 15) and/or CIN (p < 0.001).
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Figure 3: Kaplan-Meier analysis for cumulative hazard of patient mortality. There was a tendency toward higher mortality in patients with diastolic dysfunction (E/E’ > 15) and/or CIN (p < 0.001).

Mentions: Kaplan-Meier analysis showed higher mortality rates in patients who developed CIN (n = 18, 28.1% vs. n = 11, 1.6%). In addition, there was a tendency toward higher mortality in those with diastolic dysfunction and CIN (n = 14, 33.3%) (Figure 3). The two-year survival rates were 98.1% in patients without CIN or diastolic dysfunction, 95.8% in patients with diastolic dysfunction but no CIN, 72.6% in subjects with CIN and normal diastolic function, and 58.1% in patients with both CIN and diastolic dysfunction (p < 0.001).


Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study.

Koo HM, Doh FM, Ko KI, Kim CH, Lee MJ, Oh HJ, Han SH, Kim BS, Yoo TH, Kang SW, Choi KH - BMC Nephrol (2013)

Kaplan-Meier analysis for cumulative hazard of patient mortality. There was a tendency toward higher mortality in patients with diastolic dysfunction (E/E’ > 15) and/or CIN (p < 0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3717078&req=5

Figure 3: Kaplan-Meier analysis for cumulative hazard of patient mortality. There was a tendency toward higher mortality in patients with diastolic dysfunction (E/E’ > 15) and/or CIN (p < 0.001).
Mentions: Kaplan-Meier analysis showed higher mortality rates in patients who developed CIN (n = 18, 28.1% vs. n = 11, 1.6%). In addition, there was a tendency toward higher mortality in those with diastolic dysfunction and CIN (n = 14, 33.3%) (Figure 3). The two-year survival rates were 98.1% in patients without CIN or diastolic dysfunction, 95.8% in patients with diastolic dysfunction but no CIN, 72.6% in subjects with CIN and normal diastolic function, and 58.1% in patients with both CIN and diastolic dysfunction (p < 0.001).

Bottom Line: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes.They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR).In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035].

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, College of Medicine, Yonsei University, 134 Shinchon-dong, Seodaemun-gu, Seoul, Korea.

ABSTRACT

Background: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN.

Methods: We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA.

Results: CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E' in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E' values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E' was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001).

Conclusions: This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.

Show MeSH
Related in: MedlinePlus