IMPACT OF CONTRAST-INDUCED NEPHROPATHY PREVENTION STRATEGIES ON PCI OUTCOMES IN HIGH-RISK PAKISTANI PATIENTS
Main Article Content
Keywords
contrast-induced nephropathy, percutaneous coronary intervention, high-risk patients, hydration therapy, renal function, healthcare costs
Abstract
Background: Percutaneous coronary intervention (PCI) is vital for managing coronary artery disease (CAD). It significantly reduces mortality and morbidity. Yet, PCI carries risks like contrast-induced nephropathy (CIN). CIN harms renal function, prolongs hospital stays, and raises healthcare costs and mortality rates. Preventive strategies, including hydration therapy, aim to mitigate CIN, particularly in high-risk patients with pre-existing conditions.
Objective: This study aimed to evaluate the impact of CIN prevention strategies, especially hydration therapy, on PCI outcomes in high-risk Pakistani patients.
Methods: Conducted at Hayatabad Medical Complex, Peshawar, from January 2021 to December 2022, this study included 132 high-risk patients undergoing PCI. Participants were randomly assigned to receive either hydration therapy or no specific hydration protocol. The primary outcome was the incidence of CIN, defined as an increase in serum creatinine by 0.5 mg/dL or 25% from baseline within 30 days post-PCI. Secondary outcomes included the length of hospital stay and 30-day mortality rate. Data were collected through medical records and direct interviews. Statistical analyses were performed using SPSS version 26.0.
Results: The incidence of CIN was 10.6%, with the highest rates in patients with pre-existing chronic kidney disease (CKD) (18.4%). Hydration therapy significantly reduced CIN incidence to 5.4% compared to 15.7% in those without hydration. Patients with CIN had longer hospital stays (mean ± SD: 6.3 ± 2.1 days) compared to those without CIN (4.1 ± 1.5 days). The 30-day mortality rate was higher in CIN patients (7.1%) versus non-CIN patients (2.9%). Statistical analyses demonstrated significant differences in CIN incidence, hospital stay length, and 30-day mortality rates among the groups, with p-values < 0.05.
Conclusion: Hydration therapy significantly reduces CIN incidence and improves outcomes for high-risk Pakistani patients undergoing PCI. Routine hydration protocols in clinical practice can enhance patient care, reduce healthcare costs, and improve overall CAD management in Pakistan. Future research should focus on long-term outcomes, cost-effectiveness, and the influence of genetic and environmental factors on CIN.
References
2. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention. J Am Coll Cardiol. 2004 Oct 6;44(7):1393-9.
3. McCullough PA, Wolyn R, Rocher LL, et al. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med. 1997 Nov;103(5):368-75.
4. Zair H, Usha K, Umaima W, et al. An Investigation of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention: A Cross-Sectional Study From Pakistan. Cureus. 2024; doi: 10.7759/cureus.54726.
5. Nijssen EC, Nelemans PJ, Rennenberg RJ, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a randomised, open-label, phase 3 trial. Lancet. 2017 Feb 18;389(10076):1312-1322.
6. Trivedi H, Nadella R, Szabo A, et al. Hydration with sodium bicarbonate for the prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials. Clin Nephrol. 2010 Jul;74(1):19-25.
7. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002 May 28;105(19):2259-64.
8. McCullough PA, Bertrand ME, Brinker JA, et al. A meta-analysis of the renal safety of isosmolar iodixanol compared with low-osmolar contrast media. J Am Coll Cardiol. 2006 Apr 18;47(8):1588-96.
9. Nijssen EC, Rennenberg RJ, Nelemans PJ, et al. Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a randomised, open-label, controlled trial. Lancet. 2017;389(10076):1312-1322.
10. McCullough PA, Sandberg KR. Epidemiology of contrast-induced nephropathy. Rev Cardiovasc Med. 2003;4(Suppl 5).
11. Trivedi H, Nadella R, Szabo A, et al. Hydration with sodium bicarbonate for the prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials. Clin Nephrol. 2010 Jul;74(1):19-25.
12. Pannu N, Wiebe N, Tonelli M. Prophylaxis strategies for contrast-induced nephropathy. JAMA. 2006;295(23):2765-2779.
13. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105(19):2259-2264.
14. Brown JR, Robb JF, Block CA, et al. Does safe dosing of iodinated contrast prevent contrast-induced acute kidney injury? Circ Cardiovasc Interv. 2010;3(4):346-350.
15. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006 Apr;(100)
16. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105(19):2259-2264.
17. Solomon R, Werner C, Mann D, et al. Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994;331(21):1416-1420.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Muhammad Idrees Khan
Cardiologist Hayatabad Medical Complex Peshawar, Pakistan
Muhammad Naseem
ST1 Clinical Fellow, Dene Barton Community Hospital Somerset NHS Foundation Trust UK
Dr Safi Ullah
SHO Emergency Medicine, University Hospital Galway HSE Ireland
Dr Sohail Ahmed
Resident Cardiologist, SGTH Swat Pakistan
Dr Imran Qadar Khattak
Specialist Registrar Medical Ward, Hayatabad Medical Complex Peshawar, Pakistan
Muhammad Riaz Khan
Medical Officer, Health Department KPK, Pakistan