Abstract 4044: Exacerbation or Development of Hyperglycemia Predicts Peri-procedural Nephropathy
Hypothesis: Excessive urinary solute load is considered to be a central cause of contrast-induced nephropathy. While diabetes mellitus is associated with baseline renal dysfunction and increased risk of contrast-induced nephropathy, we hypothesized that an increase in solute load from the peri-procedural development or exacerbation of hyperglycemia would significantly increase the risk of nephropathy independent of contrast load, baseline renal function, and pre-procedural glucose.
Methods: 692 patients with chronic kidney disease (creatinine >1.4mg/dL not on dialysis) undergoing angiography were followed with serial creatinines to determine the frequency, magnitude, and time-course of post-procedural renal dysfunction. Pre-procedural and post-procedural serum glucose levels were measured. Change from pre-procedural to post-procedural glucose was examined as a predictor of post-procedural renal dysfunction.
Results: The mean patient age was 66.7 years, contrast load 142±80 ml, and 42% had known DM. Mean serum creatinine (Cr) was 1.8±0.5 mg/dl. The mean pre-procedural glucose was 142±69 mg/dl with a mean maximum post-procedural glucose of 155±81 mg/dl. Seventeen percent developed nephropathy (defined as an increase in Cr > 0.5 mg/dL or an increase in Cr > 25% over baseline). Change in glucose was a significant univariate predictor of percent increase in Cr (p=<0.0001) and post-procedural nephropathy (p=<0.0001). In multivariate analysis controlling for pre-procedural baseline Cr, pre-procedural glucose, contrast load, history of diabetes mellitus, pre-procedural GFR, pre-procedural BUN, and maximum post-procedural glucose, change in glucose remained a highly significant predictor of percent increase in Cr (p=<0.0001) and post-procedural nephropathy (p=<0.0001).
nConclusions: Peri-procedural change in glucose is a powerful predictor of post-procedural renal dysfunction. Every additional 50 mg/dl increase in glucose was associated with a 10.5% increase in post-procedural Cr. A strategy of tight and stable glycemic control should be prospectively evaluated for its impact on post-procedural renal dysfunction.