title: Contrast nephropathy post cardiac resynchronization therapy: an under-recognized complication with important morbidity.
abstract: OBJECTIVE
  The aim of the study was to define the incidence of contrast nephropathy in patients undergoing cardiac resynchronization therapy (CRT).
  
  
  BACKGROUND
  CRT is a promising new treatment for advanced heart failure. It is a technically demanding procedure with a recognized failure/complication rate. Contrast nephropathy is a well-recognized complication of coronary angiography/intervention, but has not been described following CRT.
  
  
  METHODS
  We performed a retrospective chart review of patients who had undergone CRT at Mount Sinai Hospital, a tertiary referral center for heart failure management, to define the incidence of contrast nephropathy in patients undergoing CRT. Contrast nephropathy was defined as the occurrence of a 25% or greater increase in serum creatinine within 48 h after contrast administration.
  
  
  RESULTS
  Sixty-eight patients underwent a total of seventy-three procedures between October 1st 2000 and December 31st 2003. Ten patients (14%) developed contrast nephropathy. Three of these patients (4%) required hemofiltration and one died. Patients with creatinine > or = 200 micromol/l (2.26 mg/dl) were more likely to develop contrast nephropathy than those with creatinine < 200 micromol/l (6/14 patients [43%] v 4/59 patients [7%], p<0.01). The mean length of hospital stay post-procedure in patients developing contrast nephropathy was 19+/-18 (SD) days versus 4+/-5 days for those patients with stable renal function (p<0.01).
  
  
  CONCLUSIONS
  Contrast nephropathy is a frequent, but under-recognized complication of CRT with important morbidity/mortality. The extended hospital stay associated with contrast nephropathy has important clinical and health care implications. Patients and physicians need to be aware of this potential risk.
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Suite 1609, Toronto, Ontario, Canada, M5G 1X5.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Cowburn
authors.forename: Harshna
authors.initials: H
authors.lastname: Patel
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Pipes
authors.forename: John D
authors.initials: JD
authors.lastname: Parker
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood*; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000628:therapy*; D006440:Hemofiltration; D006801:Humans; D007902:Length of Stay; D012189:Retrospective Studies; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D003404:Creatinine; C044834:iodixanol; C054871:ioversol