Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days

Abstract

Background: None of study mentioned about contrast-induced acute kidney injury (CI-AKI) in people who have received contrast agents twice within in a short period of time. This study is trying to identify the predictors. Methods: We enrolled 607 patients between Oct. 2010 and Jul. 2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region. The primary outcome was CI-AKI within 72 h after contrast agent exposure. Patients were divided into groups A (n = 559) and group B (n = 48) according to whether CI-AKI occurred after the second agent. Results: Patients in group B (CI-AKI occurred after the second agent) had a more rapid heart rate and more usage of diuretics and digitalis. In group B, CI-AKI occurred more frequently after the first agent. Multivariate logistic regression showed that diuretic (P = 0.006) and intra-aortic balloon pump (IABP) usage (P = 0.012) were independent predictors of CI-AKI after the first agent. Angiotensin-converting enzyme inhibitor/Angiotensin II receptor antagonist (ACEI/ARB) usage (P = 0.039), IABP usage (P = 0.040) and CI-AKI occurring after administration of the first agent (P = 0.015) were independent predictors of CI-AKI after the second. Furthermore, dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1-3 days after the first exposure than within 4-6 days (12.4% vs. 5.0%, P = 0.008) or ≥ 7 days (12.4% vs. 6.4%, P = 0.039). Conclusions: Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent. The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure, ACEI/ARB usage, and IABP usage. More importantly, a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.

Repeated Dose of Contrast Media and the Risk of Contrast-Induced Acute Kidney Injury in a Broad Population of Patients Hospitalized in Cardiology Department

“…However, this observation could be the result of the comorbidities in the patients treated with those groups of drugs, rather than the pharmacotherapy itself. Only a few previous studies address this problem, but the results are not compatible with each other [ 20 , 21 ].…”

“…Only a few publications mention CI-AKI in patients who have received CM more than once during hospitalization. In the study by Gu et al [ 20 ], CI-AKI occurred more frequently in patients who received a second dose of CM in a short period of time (12.4% for 1–3 days vs. 5.0% for 4–6 days, p = 0.008). In our study, sudden cardiac arrest was related to the higher CI-AKI frequency, while, in the cited study, intra-aortic balloon pump usage and treatment with diuretics were the independent risk factors for kidney function deterioration.…”