title: Pre-procedural renal resistive index accurately predicts contrast-induced acute kidney injury in patients with preserved renal function submitted to coronary angiography.
abstract: The study aimed to evaluate the clinical utility of ultrasonographic intra-renal blood flow parameters, together with the wide range of different risk factors, for the prediction of contrast-induced acute kidney injury (CI-AKI) in patients with preserved renal function, referred for coronary angiography or percutaneous coronary interventions (CA/PCI). This prospective study covered 95 consecutive patients (69.5% men; median age 65 years) subject to elective or urgent CA/PCI. Data regarding 128 peri-procedural variables were collected. Ultrasonographic intra-renal blood flow parameters, including renal resistive index (RRI) and pulsatility index (RPI), were acquired directly before the procedure. CI-AKI was defined as ≥50% relative or ≥0.3 mg/dL absolute increase of serum creatinine 48 h after procedure. CI-AKI was confirmed in nine patients (9.5%). Patients with CI-AKI had higher SYNTAX score (p = 0.0002), higher rate of left main disease (p < 0.00001), peripheral artery disease (PAD; p = 0.02), coronary artery anomaly (p = 0.017), more frequently underwent surgical revascularization (p = 0.0003), 'had greater...' intima-(p = 0.004) and extra-medial thickness (p = 0.001), and received higher contrast media dose (p = 0.049), more often overused non-steroidal anti-inflammatory drugs (p = 0.001), and had substantially higher pre-procedural RRI (0.69 vs. 0.62; p = 0.005) and RPI values (1.54 vs. 1.36; p = 0.017). Logistic regression confirmed age, SYNTAX score, presence of PAD, diabetes mellitus, and pre-procedural RRI independently predicted CI-AKI onset (AUC = 0.95; p < 0.0001). Pre-procedural RRI > 0.69 had 78% sensitivity and 81% specificity in CI-AKI prediction. High pre-procedural RRI seems to be a useful novel risk factor for CI-AKI in patients with preserved renal function. Coronary, peripheral and renal vascular pathology contribute to the development of CI-AKI following CA/PCI.
authors.affiliation: First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziołowa St., 40-635, Katowice, Poland. wybraniec@os.pl.|Upper Silesia Medical Centre, Public Hospital No. 7, Katowice, Poland. wybraniec@os.pl.
authors.forename: Maciej T
authors.initials: MT
authors.lastname: Wybraniec
authors.affiliation: Department of Pathophysiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Bożentowicz-Wikarek
authors.affiliation: Department of Pathophysiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Chudek
authors.affiliation: First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziołowa St., 40-635, Katowice, Poland.|Upper Silesia Medical Centre, Public Hospital No. 7, Katowice, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Mizia-Stec
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000187:drug effects* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000150:complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011673:Pulsatile Flow; D012372:ROC Curve; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012079:Renal Circulation; D018570:Risk Assessment; D012307:Risk Factors; D018617:Ultrasonography, Doppler, Pulsed; D014655:Vascular Resistance
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine
keywords: CI-AKI; Contrast-induced acute kidney injury; RPI; RRI; Renal pulsatility index; Renal resistive index