title: The incidence of clinically significant contrast-induced nephropathy following non-emergent coronary angiography.
abstract: OBJECTIVE
  The primary aim of this study was to assess the incidence of clinically significant contrast-induced nephropathy (CIN) among patients undergoing non-emergent coronary angiography.
  
  
  BACKGROUND
  Although retrospective analyses have emphasized the association of CIN with adverse patient outcomes, the actual incidence of clinically significant CIN following non-emergent coronary angiography is not clear.
  
  
  METHODS
  We prospectively identified patients with baseline estimated glomerular filtration rates (eGFR) < 60 ml/min/1.73 m(2) undergoing non-emergent coronary angiography. We measured serum creatinine 48-96 hr following angiography and assessed the incidence of CIN using two definitions, a rise in Scr > or = 25% and > or = 0.5 mg/dl. We tracked the need for dialysis, hospitalization related to kidney injury, and 30-day mortality to examine the association of CIN with these outcomes.
  
  
  RESULTS
  We enrolled 181 patients with a median eGFR of 52 ml/min/1.73 m(2). Of the 165 patients (91%) with post-procedure Scr data, the incidence of CIN was 6.1-8.5%. One patient required dialysis (0.55%) and one (0.55%) died within 30 days. Although 38 patients required hospital admission, CIN was not associated with the need for hospitalization. Patients with an increase in Scr > or = 25% demonstrated a trend toward increased risk for 30-day mortality (P = 0.09), whereas those with increments in Scr > or = 0.5 mg/dl had a marginally higher risk for dialysis (P = 0.06) and 30-day mortality (P = 0.06), although these associations failed to meet the level of statistical significance.
  
  
  CONCLUSIONS
  Biochemically defined CIN occurs in a small, but notable proportion of patients undergoing non-emergent coronary angiography. However, clinically significant CIN is very uncommon.
authors.affiliation: Renal Section and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15214, USA. weisbordsd@upmc.edu
authors.forename: Steven D
authors.initials: SD
authors.lastname: Weisbord
authors.forename: Kathryn C
authors.initials: KC
authors.lastname: Hartwig
authors.forename: Ali F
authors.initials: AF
authors.lastname: Sonel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Paul
authors.initials: P
authors.lastname: Palevsky
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D013997:Time Factors; D014283:Triiodobenzoic Acids / Q000009:adverse effects*; D015854:Up-Regulation
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D003404:Creatinine; C044834:iodixanol