Abstract 3331: Kidney Enhancement Following Percutaneous Coronary Intervention Predicts Contrast-Induced Nephropathy
Background: Contrast-induced nephropathy is associated with poor clinical outcomes. If a reliable method could be developed to predict contrast-induced nephropathy after administration of contrast media, medical management of these patients might be improved. We assessed kidney enhancement on abdominal X-ray following percutaneous coronary intervention (PCI) as a predictor of contrast-induced nephropahty.
Methods: We enrolled 126 patients undergoing PCI and performed an abdominal X-ray within 24 hours of PCI. Kidney enhancement was defined when the density of the kidneys was higher than that of the lumbar vertebrae. Serum creatinine levels were measured at baseline and 1 and 2 days after PCI. Contrast-induced nephropathy was defined as an increase of ≥ 0.5 mg/dl or ≥ 25% in serum creatinine levels within 2 days of PCI.
Results: Kidney enhancement was observed in 11 (8.7%) patients. Contrast-induced nephropathy developed in 10 of 11 (91%) patients with kidney enhancement and 7 of 115 (6.1%) patients without kidney enhancement (p < 0.0001, 95%CI = 7.1–31.2, OR = 14.9). In the multivariate analysis adjusted for age, diabetes mellitus, hypertension, anemia, contrast volume, emergency and baseline serum creatinine level, kidney enhancement remained an independent predictor of contrast-induced nephropathy (p < 0.001). The change in serum creatinine from baseline to 2 days after PCI was greater in patients with kidney enhancement (0.69 ± 0.31 mg/dl) than those without kidney enhancement (0.13±0.26 mg/dl, p = 0.001).
Conclusion: Kidney enhancement on abdominal X-ray within 24 hours of PCI is a strong predictor of contrast-induced nephropathy. This is a simple, easy and reliable test and may have a great influence on the medical management of patients undergoing PCI.