Contrast Material-Induced Renal Failure in Patients with Diabetes Mellitus, Renal Insufficiency, or Both

Parfrey, Patrick S.; Griffiths, Sheila M.; Barrett, Brendan; Paul, Michael D.; Genge, Margot; Withers, John; Nakhoul, Farid; McManamon, P J

doi:10.1097/00132586-198906000-00058

Cited by 290 publications

(377 citation statements)

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“…Depending on the definition used, CIN occurs in Ϸ1% to 15% of a general PCI population and in 20% to 40% of patients with preexisting RI. [27][28][29] The relatively low incidence of CIN in the present trial (4.6%) is probably related to the entry exclusion of patients with known severe RI, although CIN still developed in 9.7% of patients with mild to moderate baseline RI. The lack of routine daily creatinine measurements may also have led to an underestimation of the true incidence of CIN.…”

Section: Discussionmentioning

confidence: 59%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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Background-The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. Methods and Results-PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) Յ60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, PϽ0.0001) and at 1 year (12.7% versus 2.4%, PϽ0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; PϽ0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; Pϭ0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis Ն70%; 20.6% versus 11.8%, Pϭ0.024) and infarct artery reocclusion (14.7% versus 7.3%, Pϭ0.02). Conclusions-Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

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Section: Discussionmentioning

confidence: 59%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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“…The most common definition used lately is 25% relative increase or an absolute increase of 0.5 mg/dL in serum creatinine from baseline value at 48 to 72 hr after exposure to contrast media. On the basis of this definition, the overall incidence of CIN in the general population is reported to be 1.2 to 1.6% [2,3]. The incidence of CIN is even higher in selected subsets of patients with cardiovascular pathology, which is not surprising given the high prevalence of risk factors for CIN in this population.…”

Section: Introductionmentioning

confidence: 94%

“…The incidence of CIN in diabetics varies from 5.7 to 29.4% [2,25,26]. Given the high prevalence of diabetes in the general population and its ability to cause broad spectrum of cardiovascular diseases, which require radiological procedures for their diagnosis and treatment, diabetic patients represent a significant proportion of those undergoing contrast exposure.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast-induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either 0.5 mg/dl or by 25% from baseline within the first 2-3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri-procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non-ionic low-osmolar contrast media are preferred over the high-osmolar contrast media in patients with renal impairment.

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“…In a study of CIN in patients with diabetes, CKD, or both, the risk increased in patients with both diabetes and CKD, but did not increase in patients with diabetes, or patients with CKD [10]. In a metaanalysis of pooled individual patient data (n = 2,727) from 16 randomized controlled trials (RCTs) in which patients received either the iso-osmolar contrast media (iodixanol) or low-osmolar contrast media, the independent predictors of CIN included CKD, CKD plus diabetes, and the use of lowosmolar contrast media [11].…”

Section: Rationale Cq 2-1mentioning

confidence: 94%

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

et al. 2013

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Contrast Material-Induced Renal Failure in Patients with Diabetes Mellitus, Renal Insufficiency, or Both

Cited by 290 publications

References 0 publications

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Contrast‐induced nephropathy

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

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