title: Increased plasma osmolar gap is predictive of contrast-induced acute kidney injury.
abstract: Contrast-induced acute kidney injury (CIAKI) is a common complication after percutaneous coronary artery intervention (PCI).  It is urgent to find a novel, easily measurable and accurate predictor for the early detection of CIAKI.  Hyperosmolarity and large amounts of contrast media are risk factors for CIAKI.  However, there is no study on plasma osmolar gap as a predictor of CIAKI.  We enrolled 89 patients undergoing elective PCI and tested changes of serum sodium, osmolar gap, and renal function at 0, 6, 12 and 24 hours.  Plasma osmolar gap was calculated using the following formula: measured plasma osmolarity - [2(Na) + serum urea nitrogen/2.8 + glucose/18].  CIAKI was defined as follows: increase in serum creatinine of ≥ 50%, increase in serum creatinine of ≥ 0.3 mg/dL, or decrease in estimated glomerular filtration rate of ≥ 25% within 24 hours after PCI.  The incidence of CIAKI was 13.5% (12/89 patients).  The CIAKI group had higher plasma osmolar gaps 6 hours after PCI.  The adjusted hazard ratio of the plasma osmolar gap from hour 6 (1-mOsm/L increments) to the development of CIAKI was 1.12 (95% confidence interval [CI], 1.01-1.26; P = 0.041).  Sensitivity and specificity of 7 mOsm/L or higher plasma osmolar gap at hour 6 were 70.0% and 76.6%, respectively (area under the ROC curve = 0.77 [95% CI, 0.65-0.89]).  Increased plasma osmolar gap may precede the development of CIAKI in patients undergoing PCI.  In conclusion, plasma osmolar gap may be a useful predictor for the development of CIAKI.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sejoong
authors.initials: S
authors.lastname: Kim
authors.forename: Jiyoon
authors.initials: J
authors.lastname: Sung
authors.forename: Woong Chul
authors.initials: WC
authors.lastname: Kang
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Ahn
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Chin
authors.forename: Ki Young
authors.initials: KY
authors.lastname: Na
authors.forename: Kwon Wook
authors.initials: KW
authors.lastname: Joo
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Chae
authors.forename: Jin Suk
authors.initials: JS
authors.lastname: Han
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose; D001806:Blood Urea Nitrogen; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D009994:Osmolar Concentration; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010949:Plasma / Q000737:chemistry*; D016016:Proportional Hazards Models; D012680:Sensitivity and Specificity; D012964:Sodium / Q000097:blood; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D003287:Contrast Media; D012964:Sodium; D003404:Creatinine