Abstract 1242: Risk Predictors of Contrast Induced Nephropathy in Diabetic Patients Undergoing Percutaneous Coronary Intervention and the Associated Clinical Outcomes
Background: Contrast induced nephropathy (CIN) is an important complication post percutaneous coronary intervention (PCI). Diabetic patients are high risk cohort for development of CIN. We examined the clinical predictors of CIN in diabetic patients post PCI and their clinical outcomes.
Methods: A cohort of 1211 diabetic patients undergoing PCI between May 2001 and March 2007 were recruited. Patient with baseline renal impairment (glomerular filtration rate ≤60 ml/min/1.73m2) received routine prophylactic saline hydration and oral N-acetylcysteine treatment. We examined the occurrence of CIN (>25% increase of baseline creatinine within 48 hours post PCI) in this cohort and aimed to identify other clinical predictors.
Results: Incidence of CIN was lower in diabetics with mild renal impairment (glomerular filtration rate, GFR = 40 – 60 ml/min/1.73m2) who received prophylaxis compared with diabetics with normal renal function without prophylaxis (CIN rate 4.4% vs. 8.5%, p = 0.041). Diabetics with moderate to severe renal impairment (GFR 20 – 40 and <20 ml/min/1.73m2) had very high risk of developing CIN despite traditional prophylaxis (CIN rate 16.3% and 37% respectively). Other important clinical predictors of CIN in our diabetic cohort are shown in table⇓. Patients who developed CIN had higher mortality rate at 1 month (2.0% vs. 18.4%, p<0.001) and 6 month (3.3% vs. 23.8%, p<0.001).
Conclusion: Despite saline and N-acetylcysteine treatment, diabetic patients with moderate to severe renal impairment, anemia, insulin dependence, post-procedural creatinine kinase rise and high contrast volume use were at high risk of developing CIN with resultant adverse outcomes. Such patients might be offered additional CIN prophylactic therapy and closer monitoring.