title: Contrast-induced nephropathy after percutaneous coronary intervention in simple lesions: risk factors and incidence are affected by the definition utilized.
abstract: OBJECTIVE
  To compare the incidence, and risk factors, in-hospital and at the 18-month prognosis of contrast-induced nephropathy (CIN) according to the definition utilized: as an increase in serum creatinine (Scr) ≥ 0.5 mg/dL (CIN 1) or as an increase in Scr ≥ 25% above baseline values (CIN 2).
  
  
  RESULTS
  We prospectively evaluated CIN according to two different definitions in 150 patients who underwent percutaneous coronary intervention (PCI) in simple lesions employing a low-medium dose of contrast media. Incidence of CIN was higher using the CIN 2 definition than CIN 1 (9.3% vs. 4%; p=0.0133). Patients with CIN 1 had a higher incidence of chronic kidney disease (CKD) (66.7% vs. 13.9%; p=0.006), higher mean serum creatinine levels (1.35±0.42 vs. 0.98±0.35; p=0.001) and lower mean eGFR levels (58.3±19.6 vs. 84±25.9; p=0.002). Patients with CIN 2 had a higher incidence of anemia (57.1% vs. 30.9%; p=0.049) and a higher mean contrast media volume was used (142.6±62.2 mL vs. 110.6±57.2 mL; p=0.05). In the multivariate analysis the only significant variable associated with CIN (CIN 2) was a higher volume of contrast media (OR=1.01; p=0.04). There were no differences in the major in-hospital events, but patients with CIN (both definitions) had a longer in-hospital stay. A persistent rise in serum creatinine at discharge occurred in only one patient. There were no differences between patients with and without CIN in events at the follow-up, with the exception of an increased risk of new hospitalization in patients with CIN 2.
  
  
  CONCLUSIONS
  After PCI employing low-medium dose of contrast media the incidence of CIN varied according to the definition used. Neither of the two definitions offers additional information compared with the other. Chronic kidney disease and baseline parameters of renal function are the risk factors associated with CIN 1; anemia and higher volume of contrast media are associated with CIN 2.
authors.affiliation: Cardiology Unit, University of Palermo, Italy. marcar@unipa.it
authors.forename: Marco
authors.initials: M
authors.lastname: Caruso
authors.forename: Fabio
authors.initials: F
authors.lastname: Balasus
authors.forename: Egle
authors.initials: E
authors.lastname: Incalcaterra
authors.forename: Aldo
authors.initials: A
authors.lastname: Ruggieri
authors.forename: Salvatore
authors.initials: S
authors.lastname: Evola
authors.forename: Khalil
authors.initials: K
authors.lastname: Fattouch
authors.forename: Umberto M
authors.initials: UM
authors.lastname: Bracale
authors.forename: Emanuele
authors.initials: E
authors.lastname: Amodio
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Novo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Andolina
authors.forename: Salvatore
authors.initials: S
authors.lastname: Novo
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D003404:Creatinine