Hypertension is an independent risk factor for contrast nephropathy after percutaneous coronary intervention

Conen, David; Buerkle, Gerd; Perruchoud, André P.; Buettner, Heinz Joachim; Müeller, Christian

doi:10.1016/j.ijcard.2005.09.014

Cited by 26 publications

(16 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Also, hypertension was shown to be an independent predictor of AKI following cardiothoracic surgery and percutaneous coronary intervention. 15,16 Chronic obstructive pulmonary disease has been shown to be an independent predictor of AKI in patients undergoing cardiac surgery, 1,17 and the present study also demonstrated that this comorbidity increased the risk of AKI following TAVI by greater than two-fold. Anand et al .…”

Section: Discussionsupporting

confidence: 62%

Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement

Bagur

Webb

Nietlispach

et al. 2009

European Heart Journal

427

288

View full text Add to dashboard Cite

AimsVery few data exist on the occurrence of acute kidney injury (AKI) associated with transcatheter aortic valve implantation (TAVI). The objectives of the present study were (i) to determine the incidence, predictive factors, and prognostic value of AKI following TAVI, and (ii) to compare the occurrence of AKI in TAVI vs. surgical aortic valve replacement (SAVR) in patients with pre-procedural chronic kidney disease (CKD).Methods and resultsA total of 213 patients (mean age 82 ± 8 years) undergoing TAVI for the treatment of severe aortic stenosis were included in the study. Acute kidney injury was defined as a reduction of >25% in estimated glomerular filtration rate (eGFR) within 48 h following the procedure or the need for haemodialysis during index hospitalization. Those patients with pre-procedural CKD (eGFR <60 mL/min/1.73 m2, n = 119) were compared with 104 contemporary patients with CKD who underwent isolated SAVR. The incidence of AKI following TAVI was 11.7%, with 1.4% of the patients requiring haemodialysis. Predictive factors of AKI were hypertension (OR: 4.66; 95% CI: 1.04–20.87), chronic obstructive pulmonary disease (OR: 2.64, 95% CI: 1.10–6.36), and peri-operative blood transfusion (OR: 3.47, 95% CI: 1.30–9.29). Twenty-one patients (9.8%) died during index hospitalization, and the logistic EuroSCORE (OR: 1.03 for each increase of 1%; 95% CI: 1.01–1.06) and occurrence of AKI (OR: 4.14, 95% CI: 1.42–12.13) were identified as independent predictors of postoperative mortality. Patients with CKD who underwent TAVI were older, had a higher logistic EuroSCORE and lower pre-procedural eGFR values compared with those who underwent SAVR (P < 0.0001 for all). The incidence of AKI was lower (P = 0.001; P = 0.014 after propensity score adjustment) in CKD patients who underwent TAVI (9.2%, need for haemodialysis: 2.5%) compared with those who underwent SAVR (25.9%, need for haemodialysis: 8.7%).ConclusionAcute kidney injury occurred in 11.7% of the patients following TAVI and was associated with a greater than four-fold increase in the risk of postoperative mortality. Hypertension, chronic obstructive pulmonary disease, and blood transfusion were predictive factors of AKI. In those patients with pre-procedural CKD, TAVI was associated with a significant reduction of AKI compared with SAVR.

show abstract

Section: Discussionsupporting

confidence: 62%

Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement

Bagur

Webb

Nietlispach

et al. 2009

European Heart Journal

427

288

View full text Add to dashboard Cite

show abstract

“…A cute kidney injury (AKI) is a serious complication of PCI and is associated with an increased risk of myocardial infarction, dialysis and death. [1][2][3][4][5] It is common, with a reported incidence after PCI of between 3% and 19% and can be mitigated by the use of hydration and the avoidance of excess contrast. [6][7][8][9] It is also associated with a number of preprocedural clinical factors such as pre-existing chronic kidney disease that make it an ideal target for risk modeling.…”

mentioning

confidence: 99%

Validated Contemporary Risk Model of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions: Insights From the National Cardiovascular Data Registry Cath‐PCI Registry

Tsai

Patel

Chang

et al. 2014

JAHA

182

164

View full text Add to dashboard Cite

BackgroundWe developed risk models for predicting acute kidney injury (AKI) and AKI requiring dialysis (AKI‐D) after percutaneous coronary intervention (PCI) to support quality assessment and the use of preventative strategies.Methods and ResultsAKI was defined as an absolute increase of ≥0.3 mg/dL or a relative increase of 50% in serum creatinine (AKIN Stage 1 or greater) and AKI‐D was a new requirement for dialysis following PCI. Data from 947 012 consecutive PCI patients and 1253 sites participating in the NCDR Cath/PCI registry between 6/09 and 7/11 were used to develop the model, with 70% randomly assigned to a derivation cohort and 30% for validation. AKI occurred in 7.33% of the derivation and validation cohorts. Eleven variables were associated with AKI: older age, baseline renal impairment (categorized as mild, moderate, and severe), prior cerebrovascular disease, prior heart failure, prior PCI, presentation (non‐ACS versus NSTEMI versus STEMI), diabetes, chronic lung disease, hypertension, cardiac arrest, anemia, heart failure on presentation, balloon pump use, and cardiogenic shock. STEMI presentation, cardiogenic shock, and severe baseline CKD were the strongest predictors for AKI. The full model showed good discrimination in the derivation and validation cohorts (c‐statistic of 0.72 and 0.71, respectively) and identical calibration (slope of calibration line=1.01). The AKI‐D model had even better discrimination (c‐statistic=0.89) and good calibration (slope of calibration line=0.99).ConclusionThe NCDR AKI prediction models can successfully risk‐stratify patients undergoing PCI. The potential for this tool to aid clinicians in counseling patients regarding the risk of PCI, identify patients for preventative strategies, and support local quality improvement efforts should be prospectively tested.

show abstract

“…RCN is usually defined as an absolute increase in serum creatinine of 0.5 mg/dL or a relative increase of 25% above baseline value several days after contrast administration. [1][2][3][4] RCN is a leading cause of hospital-acquired renal insufficiency 5 and is associated with increased mortality both during hospitalization and after discharge. 1,4,[6][7][8] The rate of RCN after ED CECT varies greatly by study and has been reported as 2% to 3% in patients undergoing computed tomography (CT) angiography for stroke, [9][10][11] 2% to 5% in trauma patients undergoing various studies, [12][13][14][15] 4.5% in patients undergoing abdominal CECT, 16 9% to 12% in patients undergoing CT angiography for pulmonary embolism, 17,18 and 11% to 21% in unselected patients undergoing ED CECT for various reasons.…”

mentioning

confidence: 99%

Risk Factors for Radiocontrast Nephropathy After Emergency Department Contrast‐enhanced Computerized Tomography

Traub

Kellum

Tang

et al. 2013

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Radiocontrast nephropathy (RCN) is a known complication of procedures in which intravascular iodinated contrast material is used. The authors sought to determine the risk factors for RCN after emergency department (ED) contrast-enhanced computerized tomography (CECT).Methods: This was a retrospective case-control study of patients presenting to a tertiary care ED between January 1, 2004, and December 31, 2006. Inclusion criteria were CECT performed in the ED, serum creatinine measured prior to CECT, and serum creatinine measured 48 to 96 hours after CECT. Exclusion criterion was dialysis-dependent renal failure prior to CECT. The outcome of RCN was defined as an absolute creatinine increase of greater than or equal to 0.5 mg/dL, or a 25% increase above baseline. The charts of all RCN patients and a random sample of non-RCN patients were reviewed to document the presence or absence of potential risk factors. Univariate analysis was performed using chisquare and multiple logistic regression applying a weighted technique to account for sampling of non-RCN patients.Results: Among the 5,006 patients meeting inclusion criteria, 349 (7%) developed RCN. Multiple regression analysis demonstrated that serum creatinine > 2 mg/dL, liver disease, heart failure, hematocrit < 30%, hypertension, and diabetes were risk factors for RCN, whereas age > 75 years, vascular disease, and serum creatinine > 1.5 mg/dL were not. The area under the curve (AUC) for the model was 0.65. Although the risk of RCN increased with the number of risk factors present, we could not develop a model with sufficient diagnostic accuracy to guide clinical decision-making. Conclusions:The authors report risk factors for RCN in a large case-control study, but could not develop an accurate decision tool to identify patients at increased risk for RCN after ED CECT.ACADEMIC EMERGENCY MEDICINE 2013; 20:40-45 © 2013 by the Society for Academic Emergency Medicine R adiocontrast nephropathy (RCN) is a known complication of procedures that use intravascular radiocontrast media. Although most of the medical literature regarding RCN describes patients undergoing coronary procedures, RCN may occur after emergency department (ED) contrast-enhanced computerized tomography (CECT) as well. RCN is usually defined as an absolute increase in serum creatinine of 0.5 mg/dL or a relative increase of 25% above baseline value several days after contrast administration. [1][2][3][4] RCN is a leading cause of hospital-acquired renal insufficiency 5 and is associated with increased mortality both during hospitalization and after discharge. 1,4,[6][7][8] The rate of RCN after ED CECT varies greatly by study and has been reported as 2% to 3% in patients undergoing computed tomography (CT) angiography for stroke, 9-11 2% to 5% in trauma patients undergoing various studies, [12][13][14][15] 4.5% in patients undergoing

show abstract

Hypertension is an independent risk factor for contrast nephropathy after percutaneous coronary intervention

Cited by 26 publications

References 27 publications

Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement

Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement

Validated Contemporary Risk Model of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions: Insights From the National Cardiovascular Data Registry Cath‐PCI Registry

Risk Factors for Radiocontrast Nephropathy After Emergency Department Contrast‐enhanced Computerized Tomography

Contact Info

Product

Resources

About