Abstract 11118: Pre-procedural Blood Glucose is Associated with Acute Kidney Injury in Nondiabetics
Introduction: Diabetes mellitus is a risk factor for contrast-induced acute kidney injury (AKI), but the effect of hyperglycemia before percutaneous coronary intervention (PCI) is not well-described.
Hypothesis: We hypothesized that elevated pre-procedure blood glucose would increase the risk of AKI, regardless of diabetes history.
Methods: A total of 12392 patients undergoing PCI were retrospectively analyzed. The primary endpoint was the development of contrast-induced AKI, defined as an absolute creatinine increase ≥0.3 mg/dL or a relative increase ≥50%. Pre-procedure glucose was categorized as <110, 110 to <140, and >140 mg/dL. Patients on chronic dialysis or presenting with shock were excluded. Multivariable logistic regression, stratified by history of diabetes mellitus, was performed to assess the independent effect of pre-PCI glucose upon AKI. This included the effect of specific therapies for diabetes and hypertension upon the risk of AKI.
Results: 423 patients (8.1%) with glucose <110, 304 (10.4%) with glucose 110 to 140, and 457 (14.3%) with glucose >140 developed contrast-induced AKI (p<0.001 for trend). Univariable analysis showed this effect was significant in the nondiabetic cohort, but not significant in the diabetic cohort. Absolute difference of pre- to post-procedure creatinine did not vary by pre-procedure glucose. After multivariable adjustment, pre-procedural glucose >140 increased the risk of contrast-induced AKI in both diabetics (OR 1.36, 95% CI 1.02–1.81, p=0.04) and nondiabetics (OR 1.39, 95% CI 1.04–1.86, p=0.03; Table). Hypertension, lower creatinine clearance, and higher contrast volume increased the risk of AKI only in diabetics. Patients taking angiotensin receptor blockers, however, were less likely to suffer contrast-induced AKI in both groups.
Conclusions: Elevated pre-procedural blood glucose increases the risk of contrast-induced AKI in both diabetic and nondiabetic patients.
- © 2010 by American Heart Association, Inc.