Pre-procedural glucose levels and the risk for contrast-induced acute kidney injury in patients undergoing coronary angiography.
OBJECTIVE
We sought to evaluate whether pre-procedural glucose levels are associated with contrast-induced acute kidney injury (CI-AKI) after coronary angiography.


BACKGROUND
Although diabetes is a known risk factor for CI-AKI in patients undergoing coronary angiography, whether elevated pre-procedural glucose levels (regardless of pre-existing diabetes) are associated with higher risk for CI-AKI is unknown.


METHODS
We evaluated 6,358 patients with acute myocardial infarctions undergoing coronary angiography. Patients were stratified into 5 pre-procedural glucose groups: <110 mg/dl, 110 to <140 mg/dl, 140 to <170 mg/dl, 170 to <200 mg/dl, and >or=200 mg/dl. Logistic regression models were used to evaluate the relationship between glucose levels and risk for CI-AKI, first in the entire cohort and then in patients with and without established diabetes. The primary outcome was CI-AKI (>or=0.3 mg/dl absolute or >or=50% relative serum creatinine increase during 48 h after the procedure).


RESULTS
The relationship between pre-procedural glucose and CI-AKI varied markedly in patients with and without diabetes. There was a strong association between glucose and CI-AKI risk in patients without diabetes (CI-AKI rates across the 5 glucose groups from lowest to highest: 8.2%, 9.9%, 12.4%, 14.9%, and 24.3%; p<0.001), but not in patients with diabetes (20.9%, 16.1%, 16.3%, 14.8%, and 19.2%, respectively; p=0.24; p for glucose x diabetes interaction<0.001). After adjusting for confounders (including baseline glomerular filtration rate), the relationship between higher glucose and greater CI-AKI risk persisted in patients without diabetes (odds ratios [95% confidence intervals] for glucose groups of 110 to <140 mg/dl, 140 to <170, mg/dl 170 to <200 mg/dl, and >or=200 mg/dl: 1.31 [1.00 to 1.71], 1.51 [1.11 to 2.10], 1.58 [1.03 to 2.43], and 2.14 [1.46 to 3.14] vs. glucose<110 mg/dl, respectively), but this relationship was not seen in patients with established diabetes.


CONCLUSIONS
Elevated pre-procedural glucose is associated with greater risk for CI-AKI in patients without known diabetes who undergo coronary angiography in the setting of acute myocardial infarction. Measures used to prevent CI-AKI should be considered in these patients.
Stolker
Joshua M
JM
Mid America Heart Institute of Saint Luke's Hospital, and University of Missouri-Kansas City, Kansas City, Missouri 64111, USA.
McCullough
Peter A
PA
Rao
Seshu
S
Inzucchi
Silvio E
SE
Spertus
John A
JA
Maddox
Thomas M
TM
Masoudi
Frederick A
FA
Xiao
Lan
L
Kosiborod
Mikhail
M
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D012307:Risk Factors
D015415:Biomarkers; D001786:Blood Glucose; D003287:Contrast Media