Contrast nephropathy post cardiac resynchronization therapy: an under-recognized complication with important morbidity.
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.
Cowburn
Peter J
PJ
Mount Sinai Hospital, 600 University Avenue, Suite 1609, Toronto, Ontario, Canada, M5G 1X5.
Patel
Harshna
H
Pipes
Rebecca R
RR
Parker
John D
JD
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*
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D003404:Creatinine; C044834:iodixanol; C054871:ioversol