title: Contrast-induced nephropathy and risk of acute kidney injury and mortality after cardiac operations.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) is a predictor of long-term morbidity and mortality. We assessed whether patients in whom CIN developed at diagnostic coronary angiography also had an increased risk of acute kidney injury (AKI) and higher mortality after cardiac operations.
  
  
  METHODS
  We evaluated 949 patients who underwent cardiac procedures at the Minneapolis Veterans Administration (VA) Medical Center from 2004 to 2010. CIN was defined as a rise in the serum creatinine (SCr) level to ≥0.5 mg/dL from baseline within 5 days after angiography. Outcomes were operative mortality and postoperative AKI using the Acute Injury Network and Risk, Injury, Failure, Loss, End-Stage (RIFLE) definitions. Multivariable logistic regression analysis adjusting for the VA mortality risk score was performed to assess the effect of CIN on postoperative mortality.
  
  
  RESULTS
  Of the 949 patients, 62 (6.5%) experienced CIN after coronary angiography. Short (30-day) and long-term postoperative mortality was higher in patients who experienced CIN versus those who did not (6.5% versus 1.2% and 23% versus 10%, respectively; both p<0.01). In multivariable analysis, the development of CIN was associated with a 4.2-fold increase in postoperative mortality after cardiac procedures (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.3-13.7; p=0.02). CIN was also associated with increased risk of postoperative AKI according to the Acute Kidney Network and RIFLE definitions (p<0.0001 for all).
  
  
  CONCLUSIONS
  The development of CIN at diagnostic angiography is an independent predictor of postoperative AKI and mortality after cardiac procedures.
authors: Division of Cardiology and Department of Internal Medicine, Veterans Administration Medical Center, and the University of Minnesota, Minneapolis, Minnesota 55417, USA. garci205@umn.edu
authors: Santiago
authors: S
authors: Garcia
authors: Byungsoo
authors: B
authors: Ko
authors: Selcuk
authors: S
authors: Adabag
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000401:mortality* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D003287:Contrast Media