title: Influence of the timing of cardiac catheterization and amount of contrast media on acute renal failure after cardiac surgery.
abstract: BACKGROUND
  There is limited data about the influence of timing of cardiac surgery in relation to diagnostic angiography and/or the impact of the amount of contrast media used during angiography on the occurance of acute renal failure (ARF). Therefore, in the present study the effect of the time interval between diagnostic angiography and cardiac surgery and also the amount of contrast media used during the diagnostic procedure on the incidence of ARF after cardiac surgery was investigated.
  
  
  METHODS
  Data of 1177 patients who underwent different types of cardiac surgeries after cardiac catheterization were prospectively examined. The influence of time interval between cardiac catheterization and surgery as well as the amount of contrast agent on postoperative ARF were assessed using multivariable logistic regression.
  
  
  RESULTS
  The patients who progressed to ARF were more likely to have received a higher dose of contrast agent compared to the mean dose. However, the time interval between cardiac surgery and last catheterization was not significantly different between the patients with and without ARF (p = 0.05). Overall, postoperative peak creatinine was highest on day 0, then decreased and remained significantly unchanged after this period. Overall prevalence of acute renal failure during follow-up period had a changeable trend and had the highest rates in days 1 (53.57%) and 6 (52.17%) after surgery. Combined coronary bypass and valve surgery were the strongest predictor of postoperative ARF (OR: 4.976, CI = 1.613-15.355 and p = 0.002), followed by intra-aortic balloon pump insertion (OR: 6.890, CI = 1.482-32.032 and p = 0.009) and usage of higher doses of contrast media agent (OR: 1.446, CI = 1.033-2.025 and p = 0.031).
  
  
  CONCLUSIONS
  Minimizing the amount of contrast agent has a potential role in reducing the incidence of postoperative ARF in patients undergoing cardiac surgery, but delaying cardiac surgery after exposure to these agents might not have this protective effect.
authors.affiliation: Assistant Professor, Department of Cardiac Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohsen Mirmohammad
authors.initials: MM
authors.lastname: Sadeghi
authors.forename: Mojgan
authors.initials: M
authors.lastname: Gharipour
authors.forename: Peiman
authors.initials: P
authors.lastname: Nilforoush
authors.forename: Hamid
authors.initials: H
authors.lastname: Shamsolkotabi
authors.forename: Hamid Mirmohammad
authors.initials: HM
authors.lastname: Sadeghi
authors.forename: Amjad
authors.initials: A
authors.lastname: Kiani
authors.forename: Pouya Mirmohammad
authors.initials: PM
authors.lastname: Sadeghi
authors.forename: Niloufar
authors.initials: N
authors.lastname: Farahmand
references.citation: J Am Coll Cardiol. 2004 Oct 6;44(7):1393-9
references.pmid: 15464318
references.citation: Perfusion. 1994;9(5):319-26
references.pmid: 7833539
references.citation: Am J Med. 1997 Nov;103(5):368-75
references.pmid: 9375704
references.citation: CMAJ. 2005 May 24;172(11):1461-71
references.pmid: 15911862
references.citation: Am J Cardiol. 2005 Jan 1;95(1):13-9
references.pmid: 15619387
references.citation: Inflamm Allergy Drug Targets. 2009 Mar;8(1):17-20
references.pmid: 19275689
references.citation: Br J Radiol. 1998 Apr;71(844):357-65
references.pmid: 9659127
references.citation: Am J Cardiol. 2008 Apr 15;101(8):1112-8
references.pmid: 18394443
references.citation: J Am Coll Cardiol. 2008 Apr 15;51(15):1419-28
references.pmid: 18402894
references.citation: Circulation. 1997 Feb 18;95(4):878-84
references.pmid: 9054745
references.citation: J Thorac Cardiovasc Surg. 2010 Jun;139(6):1539-44
references.pmid: 19969314
references.citation: Nephrol Dial Transplant. 1999 May;14(5):1158-62
references.pmid: 10344355
references.citation: Circulation. 2006 Nov 21;114(21):2208-16; quiz 2208
references.pmid: 17088458
references.citation: J Thorac Cardiovasc Surg. 1994 Jun;107(6):1489-95
references.pmid: 8196394
references.citation: J Am Soc Nephrol. 1994 Aug;5(2):125-37
references.pmid: 7993992
references.citation: Curr Vasc Pharmacol. 2003 Oct;1(3):321-8
references.pmid: 15320478
references.citation: Ann Thorac Surg. 2007 Oct;84(4):1264-71
references.pmid: 17888981