Predictors for contrast media-induced nephropathy and long-term survival: prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial.
BACKGROUND
Among the numerous studies concerning contrast media-induced nephropathy (CIN), there was no prospective trial that provided data on the long-term outcomes.


OBJECTIVE
To prospectively assess predictors of CIN and long-term outcomes of affected patients.


METHODS
Four hundred twelve consecutive patients with serum creatinine levels of 115 micromol/L to 309 micromol/L (1.3 mg/dL to 3.5 mg/dL) undergoing elective coronary angiography were included. Patients were randomly assigned to periprocedural hydration alone, hydration plus one-time hemodialysis or hydration plus N-acetylcysteine.


RESULTS
Multivariate logistic regression identified the following as predictors of CIN within 72 h (equivalent to an increase in creatinine 44.2 micromol/L [0.5 mg/dL] or more) : prophylactic postprocedural hemodialysis (OR 2.86, 95% CI 1.07 to 7.69), use of angiotensin-converting enzyme inhibitors (OR 6.16, 95% CI 2.01 to 18.93), baseline glomerular filtration rate (OR 0.94, 95% CI 0.90 to 0.98) and the amount of contrast media given (OR 1.01, 95% CI 1.00 to 1.01). With regard to long-term outcome (mean follow-up 649 days), multivariate Cox regression models found elevated creatinine levels at 30 days (hazard rate ratio [HRR] 5.48, 95% CI 2.85 to 10.53), but not CIN within 72 h (HRR 1.12, 95% CI 0.63 to 2.02), to be associated with increased mortality. In addition, independent predictors for death during follow-up included left ventricular ejection fraction lower than 35% (HRR 4.01, 95% CI 2.22 to 7.26), serum phosphate (HRR 1.64, 95% CI 1.10 to 2.43) and hemoglobin (HRR 0.80, 95% CI 0.67 to 0.96).


CONCLUSIONS
From the present prospective trial, performance of postprocedural hemodialysis, use of angiotensin-converting enzyme inhibitors, reduced baseline glomerular filtration rate and amount of contrast media were independent predictors of CIN within 72 h after catheterization. Assessing renal function after 30 days, rather than within 72 h, seemed to be more predictive for patients' long-term survival.
Hölscher
Birgit
B
Medizinische Klinik und Poliklinik C, University Hospital of Münster, Germany.
Heitmeyer
Christine
C
Fobker
Manfred
M
Breithardt
Günter
G
Schaefer
Roland M
RM
Reinecke
Holger
H
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000401:mortality* / Q000628:therapy; D000367:Age Factors; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003404:Creatinine / Q000097:blood; D004231:Diuresis / Q000502:physiology; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors
D003287:Contrast Media; D004232:Diuretics; D003404:Creatinine