337 Incidence and risk factors of contrast-induced nephropathy after coronarography

The incidence of contrast-induced nephropathy (CIN) is variably estimated among studies. CIN is associated with increased morbi-mortality.AimTo determine the incidence of CIN and to identify its risk factors.Methods and populationIn this cohort study, 1800 consecutive patients (age=58.9±11.1years [30–84], 62.8% males, 41.1% diabetics, and 22.8% with creatinine clearance 60ml/min) with variaous diagnoses had a coronarography investigation and were prospectively enrolled. CIN was defined by an acute impairment of the renal function occurring within 3 days after contrast media administration in the absence of an alternative etiology with an elevation of the serum creatinine level by 0.5mg/dl or 25%. The incidence of CIN was 17.2%. Factors related to CIN were: Age>60 years, diabetes, creatinine clearance < 80ml/min, emergency investigation, left ventricular ejection fraction (LVEF) < 45%, multi-vessel coronary lesions or lesion of left main coronary artery, per-procedural hypotension (systolic pressure < 80mmHg), treatment with furosemide or antispirinolactone diuretics and volume of injected contrast media (CMV) > 90ml. In a multivariate step wise model, 5 independent risk factors of CIN were identified: per-procedural hypotension (hazard ratio (HR)=3.99, CI95% [1.65–9.66], p=0.002), creatinine clearance <80ml/min (HR=2.87, CI95% [1.59–5.19], p<0.001), diabetes (HR=2.26, CI95% [1.29–3.98], p=0.005), LVEF<45% (HR=2.03, CI95%[1.22–3.39], p=0.007), and CMV >90ml (HR=1.72, CI95% [0.99–2.99], p=0.054). Age is related to creatinine clearance and increases the risk of CIN through this factor. Renal insufficiency and diabetes are mutually enhancing factors for CIN. 93% of our patients recover normal renal function within 15 days. 2 deaths and 2 terminal renal insufficiencies were noted in patients with CIN within 3 months of follow-up.ConclusionDelimitating a target population with risk factors of CIN is a key step for its prevention