Who is at risk? understanding vulnerability to contrast-induced nephropathy
F Rodrigues Santos, J Gouveia Fiuza, G Ferreira, O Kungel, M Duarte Almeida, L Afonso Santos, A Costa, I Fiuza PiresAbstract
Introduction
Contrast-induced nephropathy (CIN) remains a common complication, affecting 5–10% of patients undergoing percutaneous coronary intervention (PCI). While its association with pre-existing renal disease and excessive use of iodinated contrast has been extensively studied, other precipitating factors should also be identified to enable the prompt adoption of preventive strategies. This study aims to identify the main comorbidities, laboratory abnormalities and medications associated with CIN.
Methods
A retrospective study was designed, including all patients who underwent urgent or elective coronary angioplasty between January 1, 2019, and May 31, 2024, with a creatinine clearance ≥60 ml/min/1.73m² and serum creatinine ≤1.2 mg/dl, thus presuming good baseline renal function. CIN was defined as an increase of 0.5 mg/dl in serum creatinine or 0.25% increase from basal levels within the first 48 hours post-procedure. Comorbidities and potentially nephroprotective medications were identified, followed by an analysis of their impact on CIN development using Chi-square test and multivariate logistic regression.
Results
487 patients were included, 59.1% (n=289) were men, with a mean age of 66.6 ±10 years, 31.4% (n=153) diabetic, 68,6% (n=334) hypertensive, 6,6% (n=32) with active cancer, 8,2% (n=40) who underwent fibrinolysis previous to PCI, 58,5% (n=285) currently under statins, 22.8% (n=111) with Hb < 13 g/dl and 4.9% (n=24) with definitive pacemaker. Mean ClCr was 91.92 ml/min/1.73m² ± 28.26 and an average dose of iodinated contrast used of 208,61 ± 2.48 ml. A total of 44 patients, with a mean age of 67.71±13,21 years, with 52.3% (n=23) being diabetic, 77.3% (n=34) hypertensive, 45.5% (n=20) dyslipidemic, and 36.6% (n=16) anaemic developed CIN We found that patients with Diabetes (29.3% vs 52.3%; χ² = 9.765 p=0.002), Anaemia (Hb<13g/dl) (21.4% vs 36.4%; χ² = 5.062 p=0.036) and Definitive Pacemaker (4.1% vs 13.6%; χ² = 7.829 p=0.005) had an increased risk for CIN, while Hypertension (p=0.634), COPD (p=0.515), Heart Failure (p=0.405), Atrial Fibrillation (p=0.989), Statins (p=0.638), Alopurinol (p=0.409) and iSLGTs (p=0.833) seem to lack impact in trigger or avoid CIN. After univariate analysis, we conducted logistic regression to determinate independent predictors, which included Diabetes (OR: 2.819, 95% CI: 1.293–6.144, p = 0.009), Anaemia (OR: 2.093, 95% CI: 1.088–4.029, p = 0.027) and Pacemaker (OR: 10.100, 95% CI: 1.954–52.203, p = 0.006).
Conclusion
This study highlights the risk of CIN in diabetic patients, those with anaemia and those with a pacemaker (despite the small sample size in the latter group, which constitutes an important bias), suggesting the need for a targeted and preventive approach to avoid this complication in this group of patients, which has a well-documented negative prognostic impact. Although relevant, these results warrant validation in randomized controlled trials.