Association of Serum Osmolarity With Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction

Abstract

Contrast-induced nephropathy (CIN) is a prevalent and serious complication after primary percutaneous coronary intervention (pPCI). Although the association between serum osmolarity and chronic kidney disease is well established, its relation to CIN in patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI needs to be elucidated. We evaluated the predictive value of serum osmolarity for CIN development in patients with STEMI (n = 768) undergoing pPCI. Serum osmolarity on admission was calculated. The study population was divided into 2 groups according to CIN development, and both groups were compared according to clinical, laboratory, and demographic features, including the serum osmolarity. Serum osmolarity was significantly higher in patients with CIN than in those without CIN (278 [8] vs 284 [9]; P = .024). Serum osmolarity (odds ratio: 1.052; 95% confidence interval: 1.018-1.086; P = .002), hemoglobin, contrast media volume, creatinine on admission, basal SYNergy between PCI with TAXus and cardiac surgery II score, and left ventricular ejection fraction were found to be independent predictors of CIN. Serum osmolarity (given the simple calculation of this parameter on admission) can be useful to define patients with STEMI undergoing pPCI who are more likely to develop CIN.

Serum Osmolarity and Contrast-Induced Nephropathy

“…2 Perturbation of osmolarity is strongly associated with fluid-electrolyte imbalances, such as dehydration and hypernatremia, leading to adverse consequences such as increased risk of cardiovascular, cerebral, respiratory and renal disorders, and mortality. 3 –7 The Yildiz et al 1 study extended this observation to cardiovascular diseases, especially STEMI undergoing pPCI.…”

“…We read with interest the article by Yildiz et al entitled “Association of serum osmolarity with contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction.” 1 The authors identified serum hyperosmolarity as a risk factor for CIN development in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).…”

Comment on “Association of Serum Osmolarity With Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction”

“…In this study, lipid profile, thyroid-stimulating hormone, urine protein, and urine osmolality were not evaluated. 1 Blood gas testing helps to rule out other causes that increase osmolarity, such as acid–base disorders, anion gap acidosis, ethanol toxicity, lactate level, or diabetic ketoacidosis. 4 One-fourth of their patients with CIN had diabetes.…”

Reply to the Letter to the Editor Entitled “Comment on ‘Association of Serum Osmolarity With Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction’”

“…We thank Cure et al 1 for their comments about our paper entitled “Association of serum osmolarity with contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction.” 2 They stated that the usage of directly measured serum osmolality instead of calculated serum osmolarity may have affected the study results. However, directly measured serum osmolality would add cost in laboratory time, resource, and expense but calculated serum osmolarity would add no additional cost in routine practice.…”

“…Although direct measurement of serum osmolality, which is costly and time consuming, may affect the prediction of CIN development, these studies and our study support that calculated serum osmolarity, which can be obtained easily, may be used clinically to predict CIN. 2,6,7…”