title: Relationship Between the Urine Flow Rate and Risk of Contrast-Induced Nephropathy After Emergent Percutaneous Coronary Intervention.
abstract: A low urine flow rate is a marker of acute kidney injury. However, it is unclear whether a high urine flow rate is associated with a reduced risk of contrast-induced nephropathy (CIN) in high-risk patients. We conducted this study to evaluate the predictive value of the urine flow rate for the risk of CIN following emergent percutaneous coronary intervention (PCI). We prospectively examined 308 patients undergoing emergent PCI who provided consent. The predictive value of the 24-hour postprocedural urine flow rate, adjusted by weight (UR/W, mL/kg/h) and divided into quartiles, for the risk of CIN was assessed using multivariate logistic regression analysis. The cumulative incidence of CIN was 24.4%. In particular, CIN was observed in 29.5%, 19.5%, 16.7%, and 32.0% of cases in the UR/W quartile (Q)-1 (≤0.94  mL/kg/h), Q2 (0.94-1.30  mL/kg/h), Q3 (1.30-1.71  mL/kg/h), and Q4 (≥1.71  mL/kg/h), respectively. Moreover, in-hospital death was noted in 7.7%, 3.9%, 5.1%, and 5.3% of patients in Q1, Q2, Q3, and Q4, respectively. After adjusting for potential confounding predictors, multivariate analysis indicated that compared with the moderate urine flow rate quartiles (Q2 + Q3), a high urine flow rate (Q4) (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.27-5.68; P = 0.010) and low urine flow rate (Q1) (OR, 2.23; 95% CI, 1.03-4.82; P = 0.041) were significantly associated with an increased risk of CIN. Moreover, a moderate urine flow rate (0.94-1.71  mL/kg/h) was significantly associated with a decreased risk of mortality. Our data suggest that higher and lower urine flow rates were significantly associated with an increased risk of CIN after emergent PCI, and a moderate urine flow rate (0.94-1.71  mL/kg/h) may be associated with a decreased risk of CIN with a good long-term prognosis after emergent PCI.
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China (YL, LL, YL, HL, D-XW, J-BZ, DL, YZ, YL, PY, PR, SC, JC, NT); National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (CD, SC, PC); Department of Biostatistics, South China College of Cardiovascular Research, Guangdong Society of Interventional Cardiology, Guangzhou, China (SC); Duke Clinical Research Institute, Durham, North Carolina, USA (YX).
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.forename: Lixia
authors.initials: L
authors.lastname: Lin
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.forename: Hualong
authors.initials: H
authors.lastname: Li
authors.forename: Deng-Xuan
authors.initials: DX
authors.lastname: Wu
authors.forename: Jian-Bin
authors.initials: JB
authors.lastname: Zhao
authors.forename: Dan
authors.initials: D
authors.lastname: Lian
authors.forename: Yingling
authors.initials: Y
authors.lastname: Zhou
authors.forename: Yuanhui
authors.initials: Y
authors.lastname: Liu
authors.forename: Piao
authors.initials: P
authors.lastname: Ye
authors.forename: Peng
authors.initials: P
authors.lastname: Ran
authors.forename: Chongyang
authors.initials: C
authors.lastname: Duan
authors.forename: Shiqun
authors.initials: S
authors.lastname: Chen
authors.forename: Pingyan
authors.initials: P
authors.lastname: Chen
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.forename: Jiyan
authors.initials: J
authors.lastname: Chen
authors.forename: Ning
authors.initials: N
authors.lastname: Tan
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D018570:Risk Assessment; D014554:Urination / Q000502:physiology*; D014563:Urodynamics
chemical_list: D003287:Contrast Media