Contrast volume and in-hospital outcomes of dialysis patients undergoing percutaneous coronary intervention

Abstract

Toxicity resulting from retained contrast media may cause adverse cardiovascular outcomes (e.g., heart failure and cardiogenic shock) for dialysis patients. However, the association between the administered contrast volume and outcomes of dialysis patients after percutaneous coronary intervention (PCI) has not been sufficiently investigated. We evaluated 953 consecutive dialysis patients (age, 67.9 ± 9.9 years; 30.1% with acute coronary syndrome) who underwent PCI between September 2008 and March 2019. Patients were divided into two groups: those with a contrast volume ≥ 200 ml and those with a contrast volume < 200 ml. The cutoff was 200 ml because 100 ml increment of contrast volume is known to raise the risk of acute kidney injury, and 200 ml is more than the average volume used at most PCI centers. The primary endpoint was a composite of in-hospital death, post-PCI cardiogenic shock and post-PCI heart failure. A multivariable logistic regression model and smooth spline curve were constructed to assess the association between contrast volume and the primary endpoint. The median contrast volume was 157 ml (interquartile range, 115–210 ml). The overall primary endpoint incidence was 6.8% (N = 65). A contrast volume ≥ 200 ml was associated with a higher risk of the primary endpoint (odds ratio 2.91; 95% confidence interval 1.42–6.05; P = 0.004). The smooth spline curve demonstrated a linear relationship between the contrast volume and primary endpoint. In conclusions, the contrast volume was associated with adverse in-hospital outcomes of dialysis patients undergoing PCI. Attention should be focused on the contrast volume used for dialysis patients undergoing PCI.

Predictors and Prognostic Impact of Early Acute Kidney Injury in Cardiogenic Shock: Results from a Monocentric, Prospective Registry

“…This may be of significant relevance since significant part of patients with CS undergo MCS insertion, which represents one of the main predictors for hemolysis [43,44]. Finally, CS-related treatment, such as the use of contrast medium during coronary angiography, and the possible risk of renal artery occlusion in patients treated with additional MCS treatment were shown to contribute to AKI in patients with CS [13,45]. Compared to other biomarkers, the measurement of creatinine is commonly assessed during routine clinical care in patients treated at an ICU [34,40,46].…”

“…Acute kidney injury (AKI) represents a frequent complication in patients with CS affecting 33-39% of patients admitted with CS [10,11]. AKI may occur as a result of persistent hypoperfusion leading into reduced renal perfusion, the application of nephrotoxic pharmacotherapies, contrast medium, or as a result of renal venous congestion in the setting of right ventricular failure [12,13]. During routine clinical care, creatinine is the most common biomarker to assess kidney function, whereas other biomarkers (such as cystatin C [CysC], neutrophil gelatinase-associated lipocalin [NGAL], kidney injury molecule 1[KIM1]) are less frequently measured [9, [14][15][16].…”