title: Prediction of contrast-induced nephropathy by the serum creatinine level on the day following cardiac catheterization.
abstract: The majority of patients who undergo coronary arteriography are discharged from the hospital on the day of the procedure or on the following day. The aim of this study is to investigate whether the change in serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) on the day following cardiac catheterization can predict the development of contrast-induced nephropathy (CIN).
  
  
  
  This is a multicenter prospective observational study, which consists of 860 patients who underwent cardiac catheterization. We measured SCr and eGFR before cardiac catheterization, on the following day, and 48-72h post-procedure. Definition of CIN is changes in SCr ≥0.5mg/dL or ≥25% from baseline 48-72h after contrast exposure.
  
  
  
  CIN occurred in 40 patients. SCr levels significantly increased from a baseline of 1.55±1.08mg/dL to 1.79±1.26mg/dL on the following day in patients with CIN (p<0.0001), but significantly decreased from a baseline of 1.21±0.65mg/dL to 1.18±0.61mg/dL on the following day in those without CIN (p<0.0001). eGFR significantly decreased from a baseline of 47.3±28.3mL/min/1.73m2to 40.6±26.7mL/min/1.73m2on the following day in patients with CIN (p<0.0001), but significantly increased from a baseline of 53.1±22.0mg/dL to 53.6±21.2mg/dL on the following day in those without CIN (p=0.0236). Receiver operating characteristic curve analysis indicated that SCr change ≥0.1mg/dL [area under the curve (AUC)=0.852, sensitivity 72.5%, specificity 86.1%] and eGFR change ≤-1.1mL/min/1.73m2(AUC=0.789, sensitivity 85.0%, specificity 64.9%) were the best cut-off values for predicting CIN. Multivariate logistic regression showed that a change in SCr ≥0.1mg/dL [odds ratio (OR), 29.3; 95% confidence interval (CI), 10.8-96.2] and change in eGFR ≤-1.1mL/min/1.73m2(OR, 69.7; 95% CI, 13.3-952) were powerful independent predictors of CIN.
  
  
  
  Changes in SCr and eGFR on the day following cardiac catheterization predict the development of CIN.
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Japan. Electronic address: yssaito@naramed-u.ac.jp.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.affiliation: Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Japan.
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Tadateru
authors.initials: T
authors.lastname: Takayama
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Sakakibara
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Saiseikai-Suita Hospital, Suita, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ishigami
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Onoue
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis*; D000368:Aged; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D003404:Creatinine
keywords: Change in estimated glomerular filtration rate; Change in serum creatinine level; Contrast-induced nephropathy; Prediction of contrast-induced nephropathy