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AKI: Acute kidney injury, CA: Coronary angiography, percutaneous coronary intervention, CI-AKI: Contrast-induced Acute kidney injury
Background: Intravascular contrast media administration, during commonly performed diagnostic and therapeutic procedures like coronary angiography (CA) or percutaneous coronary intervention (PCI), has emerged as one of the key causes of hospital-acquired acute kidney injury (AKI). This represents a daunting clinical challenge for the global medical fraternity. This study was conducted to estimate the risk of contrast-induced AKI (CI-AKI), among Saudi patients who underwent CA or PCI at a tertiary care hospital, to understand the incidence and the underlying contributory factors of CI-AKI.
Methods: We conducted a retrospective review of patients who underwent CA or PCI from 1st January 2018 to 31st December 2020, at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
All authors had no access to information that could identify individual participants during or after data collection.
The exclusion criteria comprised age <18 years, preexisting chronic kidney disease (stage III–V), prior renal transplantation and records with missing key clinical information. Occurrence of AKI was defined using the “Kidney Disease: Improving Global Outcomes” (KDIGO) consensus definition. Statistical Package for the Social Sciences (SPSS) software, version 21 was used for statistical analysis. The prevalence is presented as a percentage with a 95% confidence level. P-value <0.05 was considered statistically significant.
Results: We reviewed 825 patient files, of which 754 met the inclusion criteria. According to the KDIGO classification, the mean overall incidence of Stage I CI-AKI in our study cohort was 8.1%, while no patients developed stage II and III AKI. The incidence of CI-AKI was 6.4% in patients <55 years of age (n=264) and 7.8% in the age group of 55-70 years. A significantly higher incidence of 13.3% was seen in patients above the age of 70 years. The increase in the incidence of CI-AKI in patients above 70 years, versus their younger counterparts was statistically significant (P = 0.075).
Conclusions: Based on the results of this study and past literature, the overall incidence of CI-AKI is around ≤10%, among patients undergoing CA or PCI; which seems lower than the high risk perception among cardiologists. While CI-AKI is a known post-procedural complication of CA or PCI, the apprehension of the potential risk of CI-AKI, should not defer or obstruct the decision to perform CA or PCI for deserving and needy candidates. Exercising caution among high-risk patients, individual risk-benefit assessment and employing well-established pre and peri-procedural prevention protocols can significantly mitigate the risk of CI-AKI; even among high-risk patients.
2. Goyal A, Daneshpajouhnejad P, Hashmi MF, et al. Acute Kidney Injury (Acute Renal Failure). StatPearls [Internet]. 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441896/
3. Ramjattan NA, Lala V, Kousa O, et al. Coronary CT Angiography. [Updated 2022 Jun 26]. In: StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470279/
4. Ahmad M, Mehta P, Reddivari AKR, et al. Percutaneous Coronary Intervention. [Updated 2022 Sep 30]. In: StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556123/
5. Andreucci M, Faga T, Pisani A, et al. Acute kidney injury by radiographic contrast media: pathogenesis and prevention. Biomed Res Int. 2014; 2014:362725. https://doi.org/10.1155/2014/362725
6. Helgason D, Long TE, Helgadottir S, et al. Acute kidney injury following coronary angiography: a nationwide study of incidence, risk factors and long-term outcomes. Journal of nephrology. 2018;31(5):721-30. https://doi.org/10.1007/s40620-018-0534-y
7. Mehran R, Faggioni M, Chandrasekhar J, et al. Effect of a contrast modulation system on contrast media use and the rate of acute kidney injury after coronary angiography. JACC: Cardiovascular Interventions. 2018;11(16):1601-10. https://doi.org/10.1016/j.jcin.2018.04.007
8. Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality. A cohort analysis. JAMA. 1996 May 15;275(19):1489-94. https://doi:10.1001/jama.1996.03530430033035
9. Solomon RJ, Mehran R, Natarajan MK, et al. Contrast-induced nephropathy and long-term adverse events: cause and effect? Clin J Am Soc Nephrol. 2009 Jul;4(7):1162-9. https://doi: 10.2215/CJN.00550109
10. Brown JR, Malenka DJ, DeVries JT, et al. Transient and persistent renal dysfunction are predictors of survival after percutaneous coronary intervention: insights from the Dartmouth Dynamic Registry. Catheter Cardiovasc Interv. 2008 Sep 1;72(3):347-354. https://doi: 10.1002/ccd.21619
11. Goldenberg I, Chonchol M, Guetta V. Reversible acute kidney injury following contrast exposure and the risk of long-term mortality. Am J Nephrol. 2009;29(2):136-44. https://doi: 10.1159/000151772
12. Harjai KJ, Raizada A, Shenoy C, et al. A comparison of contemporary definitions of contrast nephropathy in patients undergoing percutaneous coronary intervention and a proposal for a novel nephropathy grading system. Am J Cardiol. 2008 Mar 15;101(6):812-9. https://doi: 10.1016/j.amjcard.2007.10.051
13. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002 May 14;105(19):2259-64. https://doi.org/10.1161/01.CIR.0000016043.87291.33
14. Roghi A, Savonitto S, Cavallini C, et al. Atherosclerosis, Thrombosis and Vascular Biology Study Group and the Italian Society for Invasive Cardiology Investigators. Impact of acute renal failure following percutaneous coronary intervention on long-term mortality. J Cardiovasc Med (Hagerstown). 2008 Apr;9(4):375-81. doi: https://doi.org/10.2459/JCM.0b013e3282eee979
15. Maioli M, Toso A, Leoncini M, et al. Sodium bicarbonate versus saline for the prevention of contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. J Am Coll Cardiol. 2008 Aug 19;52(8):599-604. https:// doi: 10.1016/j.jacc.2008.05.026
16. Bhatt DL, Roe MT, Peterson ED, et al; CRUSADE Investigators. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA. 2004 Nov 3;292(17):2096-104. https:// doi: 10.1001/jama.292.17.2096
17. Fox CS, Muntner P, Chen AY, et al. Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: A report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network Registry. Circulation. 2010 Jan 26;121(3):357-65. https:// doi: 10.1161/CIRCULATIONAHA.109.865352
18. Freeman RV, Mehta RH, Al Badr W, et al. Influence of concurrent renal dysfunction on outcomes of patients with acute coronary syndromes and implications of the use of glycoprotein IIb/IIIa inhibitors. J Am Coll Cardiol. 2003 Mar 5;41(5):718-24. https:// doi: 10.1016/s0735-1097(02)02956-x
19. Han JH, Chandra A, Mulgund J, et al. Chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes. Am J Med. 2006 Mar;119(3):248-54. https://doi: 10.1016/j.amjmed.2005.08.057
20. Keough-Ryan TM, Kiberd BA, Dipchand CS, et al. Outcomes of acute coronary syndrome in a large Canadian cohort: impact of chronic renal insufficiency, cardiac interventions, and anemia. Am J Kidney Dis. 2005 Nov;46(5):845-55. https://doi: 10.1053/j.ajkd.2005.07.043
21. Lau JK, Anastasius MO, Hyun KK, et al. Evidence-based care in a population with chronic kidney disease and acute coronary syndrome. Findings from the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE). American Heart Journal. 2015 Sep;170(3):566-72. e1. https://doi: 10.1016/j.ahj.2015.06.025
22. Rhee JW, Wiviott SD, Scirica BM, et al. Clinical features, use of evidence-based therapies, and cardiovascular outcomes among patients with chronic kidney disease following non-ST-elevation acute coronary syndrome. Clin Cardiol. 2014 Jun;37(6):350-6. https://doi: 10.1002/clc.22253
23. Szummer K, Lundman P, Jacobson SH, et al. Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from the SWEDEHEART register. J Intern Med. 2010 Jul;268(1):40-9. https:// doi: 10.1111/j.1365-2796.2009.02204.x
24. Chertow GM, Normand SL, McNeil BJ. "Renalism": inappropriately low rates of coro- nary angiography in elderly individuals with renal insufficiency. J Am Soc Nephrol 2004;15: 2462–8. https:// doi: 10.1097/01.ASN.0000135969.33773.0B
25. Weisbord SD, Palevsky PM, Kaufman JS, et al. Contrast-Associated Acute Kidney Injury and Serious Adverse Outcomes Following Angiography. J Am Coll Cardiol. 2020 Mar 24;75(11):1311-1320. https:// doi: 10.1016/j.jacc.2020.01.023
26. Aljefree N, Ahmed F. Prevalence of cardiovascular disease and associated risk factors among adult population in the Gulf region: a systematic review. Adv Publ Health. (2015). https:// doi.org/10.1155/2015/235101
27. Al-Nozha MM, Arafah MR, Al-Mazrou YY, et al. Coronary artery disease in Saudi Arabia. Saudi Med J. (2004) 25:1165–71.
28. James MT, Ghali WA, Knudtson ML, et al. Associations between acute kidney injury and cardiovascular and renal outcomes after coronary angiography. Circulation. 2011;123(4):409-16. https://doi.org/10.1161/CIRCULATIONAHA.110.970160
29. Tsai TT, Patel UD, Chang TI, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014 Jan;7(1):1-9. https:// doi: 10.1016/j.jcin.2013.06.016. PMID: 24456715
30. Inohara T, Kohsaka S, Miyata H, et al. Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan. J Am Coll Cardiol. 2016 Apr 12;67(14):1715-22. https:// doi: 10.1016/j.jacc.2016.01.049
31. Lei L, Xue Y, Guo Z, et al. Population attributable risk estimates of risk factors for contrast-induced acute kidney injury following coronary angiography: a cohort study. BMC Cardiovasc Disord. 2020; 20:289. https:// doi: 10.1186/s12872-020-01570-6
32. Ribitsch W, Horina JH, Quehenberger F, et al. Contrast induced acute kidney injury and its impact on mid-term kidney function, cardiovascular events and mortality. Sci Rep. 2019; 9:16896. https:// doi.org/10.1038/s41598-019-53040-5
33. Morabito S, Pistolesi V, Benedetti G, et al. Incidence of contrast-induced acute kidney injury associated with diagnostic or interventional coronary angiography. J Nephrol. 2012 Nov-Dec;25(6):1098-107. https:// doi: 10.5301/jn.5000101
34. Abdalla MA, Ahmed KO, Yousef BA. Incidence and Risk Factors of Contrast-Induced Acute Kidney Injury in Sudanese Patients Undergoing Coronary Angiography: A Descriptive Prospective Study. Cureus. 2022 Feb 3;14(2):e21876. https:// doi: 10.7759/cureus.21876
35. Rear R, Bell RM, Hausenloy DJ. Contrast-induced nephropathy following angiography and cardiac interventions. Heart 2016; 102:638-648. https:// doi: 10.1136/heartjnl-2014-306962
36. De Simone B, Ansaloni L, Sartelli M, et al. Is the risk of contrast-induced nephropathy a real contraindication to perform intravenous contrast enhanced Computed Tomography for non-traumatic acute abdomen in Emergency Surgery Department? Acta Biomed. 2018 Dec 17;89(9-S):158-172. https:// doi: 10.23750/abm.v89i9-S.7891
37. Lun Z, Mai Z, Liu L, et al. Hypertension as a Risk Factor for Contrast-Associated Acute Kidney Injury: A Meta-Analysis Including 2,830,338 Patients. Kidney Blood Press Res 2021; 46:670-692. https:// doi: 10.1159/000517560
38. Calvin AD, Misra S, Pflueger A. Contrast-induced acute kidney injury and diabetic nephropathy. Nat Rev Nephrol. 2010 Nov;6(11):679-88. doi: 10.1038/nrneph.2010.116. Epub 2010 Sep 28. https:// doi: 10.1038/nrneph.2010
39. Qin Y, Tang H, Yan G, et al. A High Triglyceride-Glucose Index Is Associated With Contrast-Induced Acute Kidney Injury in Chinese Patients With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne). 2021 Jan 22; 11:522883. https:// doi: 10.3389/fendo.2020.522883
40. Xu T, Lin M, Shen X, et al. Association of the classification and severity of heart failure with the incidence of contrast-induced acute kidney injury. Sci Rep. 2021 Jul 28;11(1):15348. https:// doi.org/10.1038/s41598-021-94910-1
41. Daniele Giacoppo, Mahesh V. Madhavan, Usman Baber, et al. Impact of Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention on Short- and Long-Term Outcomes. Pooled Analysis from the HORIZONS-AMI and ACUITY Trials. Circulation: Cardiovascular Interventions. 2015;8. https:// doi: 10.1161/CIRCINTERVENTIONS.114.002475.
42. Panitchote, A., Mehkri, O., Hastings, A. et al. Factors associated with acute kidney injury in acute respiratory distress syndrome. Ann. Intensive Care 9, 74 (2019). https:// doi: 10.1186/s13613-019-0552-5
43. Ghani AA, Tohamy KY: Risk score for contrast induced nephropathy following percutaneous coronary intervention. Saudi J Kidney Dis Transpl. 2009, 20:240-245
44. Mohammed NM, Mahfouz A, Achkar K, et al: Contrast-induced nephropathy. Heart Views. 2013, 14:106-116. https:// doi: 10.4103/1995-705X.125926
45. Sidhu RB, Brown JR, Robb JF, et al. Interaction of gender and age on post cardiac catheterization contrast-induced acute kidney injury. Am J Cardiol. 2008;102(11):1482–1486. https:// doi: 10.1016/j.amjcard.2008.07.037
46. Barbieri L, Verdoia M, Nardin M, et al. Gender Difference in the Risk of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention. Angiology. 2017 Jul;68(6):542-546. https:// doi: 10.1177/0003319716669429
47. Kanic V, Vollrath M, Kompara G, et al. Women and acute kidney injury in myocardial infarction. J Nephrol. 2018 Oct;31(5):713-719. https:// doi: 10.1007/s40620-018-0504-4
48. Isaac T, Gilani S, Kleiman NS. When Prevention is Truly Better than Cure: Contrast-Associated Acute Kidney Injury in Percutaneous Coronary Intervention. Methodist Debakey Cardiovasc J. 2022 Sep 6;18(4):73-85. https:// doi: 10.14797/mdcvj.1136