title: Association of contrast-induced nephropathy with risk of adverse clinical outcomes in patients with cardiac catheterization: From the CINC-J study.
abstract: BACKGROUND
  The association between the incidence of contrast-induced nephropathy (CIN) and subsequent clinical outcomes is unclear in Japan. We evaluated the association between CIN and cardiovascular and renal events after cardiac catheterization.
  
  
  METHODS
  The CINC-J multicenter prospective cohort study examined 853 patients undergoing cardiac catheterization from 27 hospitals. CIN was defined as increase in serum creatinine (SCr)≥0.5mg/dL or ≥25% from baseline between 48 and 72h after exposure to contrast. Major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause deaths, non-fatal myocardial infarction, acute decompensated heart failure (ADHF), and stroke. Renal events included newly-required hemodialysis and increase of SCr≥2× from baseline.
  
  
  RESULTS
  During follow-up periods (477±214days), CIN, MACCE, and renal events occurred in 44 (5.2%), 71 (8.3%), and 26 (3.0%) patients, respectively. Kaplan-Meier analysis showed that CIN yielded increasing risk for MACCE, ADHF, newly-required hemodialysis, and renal events. In multivariable Cox proportional hazards analysis, age (HR: 1.03; 95% CI, 1.00-1.07; P=0.0425), anemia (HR: 1.94; 95% CI, 1.08-3.61; P=0.0264), and diabetes mellitus (HR: 1.86; 95% CI, 1.10-3.21; P=0.0119) were independent predictors of MACCE, whereas CIN (HR: 7.78; 95% CI, 3.23-17.9; P=0.0005) and SCr (HR: 2.09; 95% CI, 1.56-2.73; P=0.0006) were independent predictors of renal events. Compared to subjects without both anemia and CIN as the reference, those with both were high risk for MACCE (HR: 3.97; 95% CI, 1.25-10.6; P=0.0218).
  
  
  CONCLUSIONS
  CIN was a significant predictor of subsequent renal events after cardiac catheterization. CIN and anemia were associated with increased risk for worse long-term clinical outcome, especially when both were present.
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan. Electronic address: asato@md.tsukuba.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.affiliation: Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Murohara
authors.initials: M
authors.lastname: Toyoaki
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan.
authors.forename: Tadateru
authors.initials: T
authors.lastname: Takayama
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Sakakibara
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Saiseikai-Suita Hospital, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ishigami
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Onoue
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology*; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D006435:Renal Dialysis
chemical_list: D003287:Contrast Media
keywords: Contrast-induced nephropathy; Coronary angiography; Prognosis