Early creatinine shifts predict contrast-induced nephropathy and persistent renal damage after angiography.
OBJECTIVE
The purpose of this study was to evaluate incidence and predictors of contrast-induced nephropathy after coronary angiography and interventions, and to assess renal function at 30 days. The prognostic value of any early shift of serum creatinine compared with baseline was investigated; such measurement, being a delta, is largely independent of creatinine variations.


METHODS
There were 216 patients at risk for contrast-induced nephropathy prospectively evaluated at baseline and at 12, 24, and 48 hours after exposure to contrast media, and 190 (88%) evaluated 1 month after discharge.


RESULTS
Contrast-induced nephropathy occurred in 39 patients (18%), and 30-day renal damage was detected in 15 (7%). Contrast media/kg volume predicted contrast-induced nephropathy (P=.002), and percentage change of creatinine 12 hours from baseline was significantly higher in patients with nephropathy (P <.001). At multivariate analysis, percentage change of creatinine 12 hour-basal was the best predictor of nephropathy (P <.001). A 5% increase of its value yielded 75% sensitivity and 72% specificity (area under the curve 0.80; odds ratio 7.37; 95% confidence interval, 3.34-16.23) for early contrast-induced nephropathy detection. Furthermore, it strongly correlated with the development of renal impairment at 30 days (P=.002; sensitivity 87%, specificity 70%; area under the curve 0.85; odds ratio 13.29; 95% confidence interval, 2.91-60.64).


CONCLUSIONS
Minimal elevations of serum creatinine at 12 hours are highly predictive of contrast-induced nephropathy and 30-day renal damage after exposure to contrast media.
Ribichini
Flavio
F
Division of Cardiology, Department of Medicine, University of Verona, Ospedale Civile Maggiore, Verona, Italy. flavio.ribichini@univr.it
Graziani
Mariastella
M
Gambaro
Giovanni
G
Pasoli
Paolo
P
Pighi
Michele
M
Pesarini
Gabriele
G
Abaterusso
Cataldo
C
Yabarek
Tewoldemedhn
T
Brunelleschi
Sandra
S
Rizzotti
Paolo
P
Lupo
Antonio
A
Vassanelli
Corrado
C
D058186:Acute Kidney Injury / Q000097:blood* / Q000139:chemically induced*; D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood*; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012372:ROC Curve
D003404:Creatinine