Makoto Watanabe1, Yoshihiko Saito2, Kazutaka Aonuma3, Atsushi Hirayama4, Nagara Tamaki5, Hiroyuki Tsutsui6, Toyoaki Murohara7, Hisao Ogawa8, Takashi Akasaka9, Michihiro Yoshimura10, Akira Sato3, Tadateru Takayama4, Mamoru Sakakibara6, Susumu Suzuki7, Kenichi Ishigami11, Kenji Onoue1. 1. First Department of Internal Medicine, Nara Medical University, Kashihara, Japan. 2. First Department of Internal Medicine, Nara Medical University, Kashihara, Japan. Electronic address: yssaito@naramed-u.ac.jp. 3. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 4. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. 5. Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Japan. 6. Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Japan. 7. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 8. Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan. 9. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan. 10. Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan. 11. Department of Cardiology, Saiseikai-Suita Hospital, Suita, Japan.
Abstract
BACKGROUND: 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). METHODS: 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. RESULTS: 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/1.73m2 to 40.6±26.7mL/min/1.73m2 on 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. CONCLUSIONS: Changes in SCr and eGFR on the day following cardiac catheterization predict the development of CIN.
BACKGROUND: 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). METHODS: 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. RESULTS: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/1.73m2 to 40.6±26.7mL/min/1.73m2 on 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. CONCLUSIONS: Changes in SCr and eGFR on the day following cardiac catheterization predict the development of CIN.