Comparison of risk factors for contrast-induced acute kidney injury between patients with and without diabetes.
Although it is well known that diabetics are at a higher risk of contrast-induced acute kidney injury (CI-AKI) than nondiabetic patients, the reason for this discrepancy is not well known. Thus, in this study, we compared the predisposing factors for CI-AKI between patients with and without diabetes. We prospectively studied 290 consecutive in-hospital patients including 88 diabetics undergoing coronary angiography or a percutaneous coronary intervention in Kowsar hospital, and we compared risk factors for CI-AKI between diabetic and nondiabetic patients. CI-AKI was defined as RIFLE criteria within 48 hours after contrast exposure. The incidence of CR-AKI was significantly higher in diabetic patients compared with nondiabetics (P<0.05). The incidence of CI-AKI was significantly higher in patients with diabetes and left-ventricular ejection fraction ≤40%, hypercholesterolemia, serum creatinine ≥1.1 mg/dL, estimated glomerular filtration rate (eGFR) <90 mL/min, Contrast volume ≥80 (mL), maximum safe contrast volume factor of 1.5, and dehydration, while in nondiabetics, a significantly higher incidence of CR-AKI was observed in those with serum creatinine ≥1.1 mg/dL (P=0.02) and/or eGFR<60 mL/min (P=0.01). Multiple logistic regression analysis showed hyperchlosteremia to be the strongest predictor of AKI (P=0.01, B:14.5) in diabetics, followed by eGFR<90 (P=0.05, B:12.4) but, in nondiabetics, only eGFR<60 predicted the occurrence of CI-AKI (P=0.04, B:2.3). It seems that the predisposing factors to CI-AKI differ in diabetics and nondiabetics. In patients with diabetes, hypercholesterolemia is the strongest predictor of CI-AKI, followed by eGFR and diabetics are at risk for CI-AKI in the early stage of chronic kidney disease (stage 2), accounting for the higher incidence of CI-AKI in them.
Pakfetrat
Maryam
M
Department of Internal Medicine, Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Nikoo
Mohamad Hosein
MH
Malekmakan
Leila
L
Tabande
Mahmood
M
Roozbeh
Jamshid
J
Ganbar Ali
Raiss Jalali
RJ
Khajehdehi
Parviz
P
D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects; D048909:Diabetes Complications / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D007492:Iran; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D003287:Contrast Media