title: Contrast-induced acute kidney injury in patients undergoing cardiac resynchronization therapy-incidence and prognostic importance. Sub-analysis of data from randomized TRUST CRT trial.
abstract: BACKGROUND
  Because data on contrast-induced acute kidney injury (CI-AKI) in patients undergoing cardiac resynchronization therapy (CRT-D) are scarce, we aimed to assess the incidence, natural course and prognostic importance of this syndrome in CRT recipients.
  
  
  METHODS
  Study population consisted of 100 consecutive patients enrolled into the Triple Site Versus Standard Cardiac Resynchronization (TRUST CRT) trial, who were treated with CRT-D. Two patients were excluded up to 3 months after randomization and not analysed further. CI-AKI was defined as a rise in serum creatinine of at least 26.5 μmol/L (0.3 mg/dL) within 48 h after contrast exposure, or at least 50% increase from the baseline value during index hospital stay with CRT-D implantation according to KDIGO Clinical Practice Guideline for Acute Kidney Injury.
  
  
  RESULTS
  Among 98 subjects of TRUST CRT trial, 10 patients (10.2%) developed CI-AKI after CRT-D implantation. In patients with glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) on admission, the incidence of CI-AKI was almost twofold (15.4%) higher than in subjects with GFR ≥60 (8.3%). CRT-D recipients with CI-AKI had significantly higher mortality rate (50.0%) compared to those without CI-AKI (17.0%) during 30 months of follow-up (logrank p = 0.012). Multivariate Cox regression analysis showed CI-AKI as significant and independent risk factor for death in CRT-D recipients (hazard ratio 5.71; 95% CI 5.16-6.26; p = 0.001).
  
  
  CONCLUSIONS
  Contrast-induced acute kidney injury is a serious and frequent procedural complication of CRT-D implantation with a significant negative influence on long-term survival. The results suggest that clinical evaluation regarding renal function should be considered in CRT-D recipients, both before and after device implantation.
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, ul. Curie-Sklodowskiej 9, Zabrze, Poland, jacekmed@yahoo.com.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kowalczyk
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Lenarczyk
authors.forename: Oskar
authors.initials: O
authors.lastname: Kowalski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Podolecki
authors.forename: Pawel
authors.initials: P
authors.lastname: Francuz
authors.forename: Patrycja
authors.initials: P
authors.lastname: Pruszkowska-Skrzep
authors.forename: Mariola
authors.initials: M
authors.lastname: Szulik
authors.forename: Michal
authors.initials: M
authors.lastname: Mazurek
authors.forename: Ewa
authors.initials: E
authors.lastname: Jedrzejczyk-Patej
authors.forename: Beata
authors.initials: B
authors.lastname: Sredniawa
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D058409:Cardiac Resynchronization Therapy Devices; D003287:Contrast Media / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D017147:Defibrillators, Implantable; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019919:Prosthesis Implantation
chemical_list: D003287:Contrast Media; D003404:Creatinine