Relationship Between the Urine Flow Rate and Risk of Contrast-Induced Nephropathy After Emergent Percutaneous Coronary Intervention

Abstract

A low urine flow rate is a marker of acute kidney injury. However, it is unclear whether a high urine flow rate is associated with a reduced risk of contrast-induced nephropathy (CIN) in high-risk patients.We conducted this study to evaluate the predictive value of the urine flow rate for the risk of CIN following emergent percutaneous coronary intervention (PCI).We prospectively examined 308 patients undergoing emergent PCI who provided consent. The predictive value of the 24-hour postprocedural urine flow rate, adjusted by weight (UR/W, mL/kg/h) and divided into quartiles, for the risk of CIN was assessed using multivariate logistic regression analysis.The cumulative incidence of CIN was 24.4%. In particular, CIN was observed in 29.5%, 19.5%, 16.7%, and 32.0% of cases in the UR/W quartile (Q)-1 (≤0.94 mL/kg/h), Q2 (0.94–1.30 mL/kg/h), Q3 (1.30–1.71 mL/kg/h), and Q4 (≥1.71 mL/kg/h), respectively. Moreover, in-hospital death was noted in 7.7%, 3.9%, 5.1%, and 5.3% of patients in Q1, Q2, Q3, and Q4, respectively. After adjusting for potential confounding predictors, multivariate analysis indicated that compared with the moderate urine flow rate quartiles (Q2 + Q3), a high urine flow rate (Q4) (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.27–5.68; P = 0.010) and low urine flow rate (Q1) (OR, 2.23; 95% CI, 1.03–4.82; P = 0.041) were significantly associated with an increased risk of CIN. Moreover, a moderate urine flow rate (0.94–1.71 mL/kg/h) was significantly associated with a decreased risk of mortality.Our data suggest that higher and lower urine flow rates were significantly associated with an increased risk of CIN after emergent PCI, and a moderate urine flow rate (0.94–1.71 mL/kg/h) may be associated with a decreased risk of CIN with a good long-term prognosis after emergent PCI.

Association of Preprocedural Hyperglycemia With Contrast-Induced Acute Kidney Injury and Poor Outcomes After Emergency Percutaneous Coronary Intervention

“…The incidence of CI-AKI in patients who underwent emergency PCI was significantly higher than elective PCI because they usually accompanied by hemodynamic instability, severe heart failure, and insufficient hydration, which were reported as the important risk factors for CI-AKI after emergency PCI. 2,3,18 Therefore, it is important to identify the high-risk patients with CI-AKI undergoing emergency PCI and implement preventive measures.…”

“…Contrast-induced acute kidney injury (CI-AKI), also known as contrast-induced nephropathy (CIN), is a frequent complication in patients with acute myocardial infarction (AMI) after coronary diagnostic and interventional procedures and has a reported incidence of 5% to 25% [1][2][3][4] when using different definitions. Contrast-induced acute kidney injury is associated with dialysis, mortality, longer hospitalization, and increased health-care costs, especially among patients undergoing primary or emergency percutaneous coronary intervention (PCI).…”

Simple pre-procedure risk stratification tool for contrast-induced nephropathy

“…According to our institution's protocol, we enrolled consecutive patients undergoing CAG or PCI between January 2010 and October 2012. The details of the inclusion and exclusion criteria were described previously (8,9). The Guangdong General Hospital Ethics Committee approved the study, and written informed consent was obtained from all patients.…”

Association between urine pH and risk of contrast-associated acute kidney injury among patients after emergency percutaneous coronary intervention: a V-shape relationship?

“…CA-AKI, as the third leading cause for hospital acquired AKI, was known to increase the co-morbidities, in-hospital mortality and length of hospitalization [ 5 ]. Due to various factors including hemodynamic instability, insufficient hydration and cardiac dysfunction, the risk of CA-AKI was higher in patients undergoing emergency PCI than those undergoing elective PCI [ 15 ]. In addition to hydration and contrast agent dose reduction, pharmacological strategies such as furosemide [ 8 ], N -acetylcysteine [ 9 ], statin [ 10 ], ascorbic acid [ 11 ] and sodium bicarbonate [ 4 , 12 ] were also evaluated.…”