Mehmet Kanbay1, Dimitrie Siriopol2, Elif Ozdogan3, Baris Afsar4, Lale A Ertuglu3, Mihaela Grigore5, Alan A Sag6, Masanari Kuwabara7, Miguel A Lanaspa8, Alberto Ortiz9, Richard J Johnson8, Adrian Covic2. 1. Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey. drkanbay@yahoo.com. 2. Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania. 3. Department of Medicine, Koc University School of Medicine, Istanbul, Turkey. 4. Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey. 5. Department of Obstetrics and Gynecology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania. 6. Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, USA. 7. Department of Cardiology, Toranomon Hospital, Tokyo, Japan. 8. Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Avd. Reyes Católicos 2, 28040, Madrid, Spain. 9. Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO, USA.
Abstract
BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is a relatively common complication following primary coronary angiography (CAG) or percutaneous coronary intervention (PCI), especially in at-risk patients. The goal of this study is to evaluate the role of pre-procedural serum osmolarity as a risk factor for CIN in patients undergoing elective CAG for stable coronary artery disease (CAD). MATERIALS AND METHODS: A total of 356 stable CAD patients scheduled to undergo CAG or PCI were included in this two-center study. Serum osmolarity was calculated on admission. CIN was defined according to the KDIGO criteria. RESULTS: There were 45 (12.6%) patients who developed CIN 48-72 h after CAG or PCI. CIN patients had a higher prevalence of diabetes (51.1% in those with CIN vs 24.4% in those without CIN, p < 0.001), higher serum glucose (129 mg/dL in those with CIN vs 108 mg/dL in those without CIN, p < 0.001), blood urea nitrogen (22.4 mg/dL in those with CIN vs 19.0 mg/dL in those without CIN, p = 0.01) and serum osmolarity (294.2 mOsm in those with CIN vs 290.1 mOsm in those without CIN, p < 0.001) levels, had received a higher dose of contrast (250 mL in those with CIN vs 200 mL in those without CIN, p = 0.03) but had lower hemoglobin (12.9 g/dL in those with CIN vs 13.6 g/dL in those without CIN, p = 0.04) level. In multivariate analysis, serum osmolarity [odds ratio (OR) 1.11; 95% confidence interval (CI) 1.04-1.18 for each mOsm/L increase; p = 0.001], diabetes (OR 2.43, 95% CI 1.26-4.71; p = 0.01), C-reactive protein (OR 1.04, 95% CI 1.01-1.08 for each mg/dL increase; p = 0.02) and contrast volume (OR 34.66, 95% CI 1.25-962.22 for each L increase; p = 0.04) remained as independent predictors of CIN. Serum sodium, glucose and blood urea nitrogen contributed to the excess serum osmolarity of CIN patients. CONCLUSION: Serum osmolarity is a cheap and widely available marker that can reliably predict CIN after CAG or PCI. Future research should focus on determining a clinically optimal cutoff for serum osmolarity that would warrant preventive interventions. Furthermore, later research may investigate the role of serum osmolarity not only as a risk factor but also as a pathogenetic mechanism underlying CIN.
BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is a relatively common complication following primary coronary angiography (CAG) or percutaneous coronary intervention (PCI), especially in at-risk patients. The goal of this study is to evaluate the role of pre-procedural serum osmolarity as a risk factor for CIN in patients undergoing elective CAG for stable coronary artery disease (CAD). MATERIALS AND METHODS: A total of 356 stable CADpatients scheduled to undergo CAG or PCI were included in this two-center study. Serum osmolarity was calculated on admission. CIN was defined according to the KDIGO criteria. RESULTS: There were 45 (12.6%) patients who developed CIN 48-72 h after CAG or PCI. CIN patients had a higher prevalence of diabetes (51.1% in those with CIN vs 24.4% in those without CIN, p < 0.001), higher serum glucose (129 mg/dL in those with CIN vs 108 mg/dL in those without CIN, p < 0.001), blood ureanitrogen (22.4 mg/dL in those with CIN vs 19.0 mg/dL in those without CIN, p = 0.01) and serum osmolarity (294.2 mOsm in those with CIN vs 290.1 mOsm in those without CIN, p < 0.001) levels, had received a higher dose of contrast (250 mL in those with CIN vs 200 mL in those without CIN, p = 0.03) but had lower hemoglobin (12.9 g/dL in those with CIN vs 13.6 g/dL in those without CIN, p = 0.04) level. In multivariate analysis, serum osmolarity [odds ratio (OR) 1.11; 95% confidence interval (CI) 1.04-1.18 for each mOsm/L increase; p = 0.001], diabetes (OR 2.43, 95% CI 1.26-4.71; p = 0.01), C-reactive protein (OR 1.04, 95% CI 1.01-1.08 for each mg/dL increase; p = 0.02) and contrast volume (OR 34.66, 95% CI 1.25-962.22 for each L increase; p = 0.04) remained as independent predictors of CIN. Serum sodium, glucose and blood ureanitrogen contributed to the excess serum osmolarity of CIN patients. CONCLUSION: Serum osmolarity is a cheap and widely available marker that can reliably predict CIN after CAG or PCI. Future research should focus on determining a clinically optimal cutoff for serum osmolarity that would warrant preventive interventions. Furthermore, later research may investigate the role of serum osmolarity not only as a risk factor but also as a pathogenetic mechanism underlying CIN.
Authors: Joshua M Stolker; Peter A McCullough; Seshu Rao; Silvio E Inzucchi; John A Spertus; Thomas M Maddox; Frederick A Masoudi; Lan Xiao; Mikhail Kosiborod Journal: J Am Coll Cardiol Date: 2010-04-06 Impact factor: 24.094
Authors: Carlos A Roncal-Jimenez; Tamara Milagres; Ana Andres-Hernando; Masanari Kuwabara; Thomas Jensen; Zhilin Song; Petter Bjornstad; Gabriela E Garcia; Yuka Sato; Laura G Sanchez-Lozada; Miguel A Lanaspa; Richard J Johnson Journal: Am J Physiol Renal Physiol Date: 2016-12-21
Authors: Peter Aspelin; Pierre Aubry; Sven-Göran Fransson; Ruth Strasser; Roland Willenbrock; Knut Joachim Berg Journal: N Engl J Med Date: 2003-02-06 Impact factor: 91.245
Authors: Mehmet Ali Mendi; Baris Afsar; Fatih Oksuz; Osman Turak; Cagri Yayla; Firat Ozcan; Richard J Johnson; Mehmet Kanbay Journal: Angiology Date: 2016-03-22 Impact factor: 3.619
Authors: Mehmet Kanbay; Begum Guler; Lale A Ertuglu; Tuncay Dagel; Baris Afsar; Said Incir; Arzu Baygul; Adrian Covic; Ana Andres-Hernando; Laura Gabriela Sánchez-Lozada; Miguel A Lanaspa; Richard J Johnson Journal: Nutrients Date: 2021-06-02 Impact factor: 5.717