Contrast-induced acute kidney injury after primary percutaneous coronary interventions: Prevalence, predictive factors, and outcomes

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Aim. To study the incidence, severity, predictive factors, and prognostic value of contrast-induced acute kidney injury (CIAKI) in patients with ST-segment elevation acute coronary syndrome (STSEACS), who have undergone primary percutaneous coronary intervention (PCI). Subjects and methods. The 2012 KDIGO criteria were used to estimate the incidence of CIAKI in 216 patients (mean age, 64±13 years) admitted to Moscow City Clinical Hospital Sixty-Four and underwent primary PCI for STSEACS (hypertension in 90%, prior myocardial infarction in 27%, chronic kidney disease in 7%, type 2 diabetes mellitus in 21%). Logistic regression analysis was performed to identify predictive factors for CIAKI; following 12 months, its prognosis was assessed by phone. Results. Forty-three (20%) patients were diagnosed with Stages I (81%) and II (19%) CIAKI. The patients with CIAKI were older; they had higher baseline serum creatinine levels, a higher volume of contrast agent, a higher ratio of contrast medium volume to glomerular filtration rate, and lower left ventricular ejection fraction. Independent predictive factors for CIAKI were identified; these were chronic kidney disease, multivascular injury in the coronary bed, hospital therapy with loop diuretics, nephrotoxic antibiotics, or mineralocorticoid receptor antagonists. Conclusion. The development of CIAKI is associated with poor outcomes, such as higher 30-day mortality and more frequent cardiovascular disease readmissions.


  1. Kume K, Yasuoka Y, Adachi H, Noda Y, Hattori S, Araki R, Kohama Y, Imanaka T, Matsutera R, Kosugi M, Sasaki T. Impact of contrast-induced acute kidney injury on outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiovasc Revasc Med. 2013;14(5):253-257.
  2. Steg PG, James SK, Atar D. ESC Guidelines for themanagement of acutemyocardial infarction in patients presenting with ST-segment elevation: the Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J. 2012;33:2569-2619.
  3. Доморадская А.И. Контраст-индуцированная нефропатия: факторы риска. REJR (Российский электронный журнал радиологии). 2011;4:27-32.
  4. Волгина Г.В. Контрастиндуцированная нефропатия: патогенез, факторы риска, стратегия профилактики. Нефрология и диализ. 2006;2:176-183.
  5. Белопухов В.М., Якупов И.Ф., Айнутдинова И.А., Иванова А.Ю. Нарушения функции почек у больных с инфарктом миокарда и чрескожными коронарными вмешательствами в до- и послеоперационном периоде. Медицинский альманах. 2013;4(28):55-56.
  6. Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, Kosiborod M, Amin AP, Messenger JC, Rumsfeld JS, Spertus JA. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. J Am Coll Card Cardiovasc Interv. 2014;7(1):1-9.
  7. Watabe H, Sato A, Hoshi T, Takeyasu N, Abe D, Akiyama D, Kakefuda Y, Nishina H, Noguchi Y, Aonuma K. Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention. Int J Cardiol. 2014;174(1):57-63.
  8. Brown JR, DeVries JT, Piper WD, Robb JF, Hearne MJ, Ver Lee PM, Kellet MA, Watkins MW, Ryan TJ, Silver MT, Ross CS, MacKenzie TA, O’Connor GT, Malenka DJ. Serious renal dysfunction after percutaneous coronary interventions can be predicted. Am Heart J. 2008;155:260-266.
  9. Bellomo R, Ronco C, Kellum J, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:204-212.
  10. Mehta R, Kellum J, Shah S, Molitoris BA, Ronco C, Warnock DG, Levin A. Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
  11. KDIGO Clinical practice guideline for acute kidney injury. KidneyInt. 2012;2(1):1-141.
  12. Akrawinthawong K, Ricci J, Cannon L, Dixon S, Kupfer K, Stivers D, Patrick A, Shukri D, McCullough PA. Subclinical and clinical contrast-induced acute kidney injury: data from a novel blood marker for determining the risk of developing contrast-induced nephropathy (ENCINO), a prospective study. Renal Fail. 2014;12:Early Online:1-5.
  13. Loh JP, Pendyala LK, Kitabata H. Comparison of outcomes after percutaneous coronary intervention among different coronary subsets (stable and unstable angina pectoris and ST-segment and non-ST-segment myocardial infarction). Am J Cardiol. 2014; 113(11):1794-1801.
  14. Meinel FG, Cecco CN, Schoepf UJ, Katzberg R. Contrast-induced acute kidney injury: definition, epidemiology, and outcome. BioMed Research International. 2014;ID 859328, 6 pages.
  15. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, Mintz GS, Lansky AJ, Moses JW, Stone GW, Leon MB, Dangas G. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44:1393-1399.
  16. Руда М.Я., Голицын С.П., Грацианский Н.А. Комаров А.Л., Панченко Е.П., Староверов И.И., Терещенко С.Н., Явелов И.С. Национальные рекомендации ВНОК при участии МЗ и Социального развития по диагностике и лечению больных острым инфарктом миокарда с подъемом сегмента ST ЭКГ. Кардиоваскулярная терапия и профилактика. 2007;6(8), Приложение 1:415-500.
  17. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-612.
  18. Ronco C, Stacul F, McCullough PA. Subclinical acute kidney injury (AKI) due to iodine-based contrast media. Eur Radiol. 2013;23(2):319-323.
  19. Loh JP, Pendyala LK, Torguson R. Incidence and correlates of major bleeding after percutaneous coronary intervention across different clinical presentations. Am Heart J. 2014;168(3):248-255.
  20. James MT, Ghali WA, Knudtson ML, Ravani P, Tonelli M, Faris P, Pannu N, Manns BJ, Klarenbach SW, Hemmelgarn BR. Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography. Circulation. 2011;123:409-416.
  21. Davenport MS, Khalatbari S, Cohan RH, Dillman JR, Myles JD, Ellis JH. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 2013;268(3):719-728.
  22. Kim GS, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, Hong MK, Jang Y. Elevated serum cystatin C level is an independent predictor of contrast-induced nephropathy and adverse outcomes in patients with peripheral artery disease undergoing endovascular therapy. Vasc Surg. 2015;0741-5214(14):02228-02229.
  23. Lucreziotti S, Centola M, Salerno-Uriarte D, Ponticelli G, Battezzati PM, Castini D, Sponzilli C, Lombardi F. Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevation myocardial infarction. Int J Cardiol. 2014;174:37-42.
  24. McCullough P, Adam A, Becker C, Davidson C, Lameire N, Stacul F, Tumlin J. Risk prediction of contrast-induced nephropathy. Am J Cardiol. 2006;98:27-36.
  25. Andreucci M, Faga T, Pisani A, Sabbatini M, Russo D, Ashour M. Prevention of contrast-induced nephropathy through a knowledge of its pathogenesis and risk factors. Scientific World J. 2014; ID 823169, 16 pages.
  26. Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I, Grazi M, Veglia F, Bartorelli AL. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 2004;44:1780-1785.
  27. Anderson HV, Shaw RE, Brindis RG, Kip KE, Fine MJ, Saul MI, Palevsky PM. Risk-adjusted mortality analysis of percutaneous coronary interventions by American College of Cardiology/American Heart Association guidelines recommendations. Am J Cardiol. 2007;99:189-196.
  28. Weisbord S, Chen H, Stone R, Kip KE, Fine MJ, Saul MI, Palevsky PM. Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. J Am Soc Nephrol. 2006;17:2871-2877.
  29. Iakovou I, Dangas G, Mehran R, Lansky AJ, Ashby DT, Fahy M, Mintz GS, Kent KM, Pichard AD, Satler LF, Stone GW, Leon MB. Impact of gender on the incidence and outcome of contrast induced nephropathy after percutaneous coronary intervention. J Invasive Cardiol. 2003;15:18-22.
  30. Schilp J, de Blok C, Langelaan M, Spreeuwenberg P, Wagner C. Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy. BMC Nephrol. 2014;15:2.
  31. Rynkowska-Kidawa M, Zielińska M, Chiżyński K, Kidawa M. In-hospital outcomes and mortality in octogenarians after percutaneous coronary intervention. Kardiol Pol. 2015. doi: 10.5603/kp.a2014.0247.

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