Contrast-induced nephropathy following chronic total occlusion percutaneous coronary intervention in patients with chronic kidney disease

Eur Radiol. 2015 Aug;25(8):2274-81. doi: 10.1007/s00330-014-3360-1. Epub 2015 May 17.

Abstract

Objectives: Contrast-induced nephropathy (CIN) has not been systematically studied in high-risk patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Methods: We prospectively observed 515 consecutive patients with CKD undergoing PCI. Patients were divided into three groups: patients who underwent attempted PCI for CTO (group A, n = 85), patients who did not receive PCI for CTO (group B, n = 45) and patients without CTO (group C, n = 385).

Results: CIN developed in 55 patients (10.68 %). Group A patients received a larger CM dose than group B or group C (p = 0.024). The intravenous hydration volume, age and CIN Mehran score were not significantly different between the three groups. The incidence of CIN was 9.4 % for group A, 6.7 % for group B and 11.4 % for group C (p = 0.344). In-hospital mortality and required renal replacement therapy (p = 0.325) were not significantly different between the groups. Multivariate analysis showed that after adjusting for potential confounding factors, the odds ratio for CIN was 1.03 (p = 0.944) for group A and 0.64 for group B (p = 0.489) compared to group C.

Conclusions: Attempts to achieve recanalization of CTO in patients with CKD might not increase the risk of CIN if appropriate preventative measures are taken.

Key points: • Contrast-induced nephropathy can increase morbidity and mortality • Chronic kidney disease patients are at the greatest risk of CIN • Patients with CKD undergoing CTO-PCI are common • Incidence of CIN has not been reported in CKD patients • CTO-PCI in CKD patients might not increase the risk of CIN.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Aged
  • Contrast Media / adverse effects*
  • Coronary Occlusion / surgery*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Iohexol / adverse effects
  • Iohexol / analogs & derivatives
  • Iopamidol / adverse effects
  • Male
  • Percutaneous Coronary Intervention / adverse effects*
  • Prospective Studies
  • Renal Insufficiency, Chronic / complications*
  • Risk Factors

Substances

  • Contrast Media
  • Iohexol
  • iopromide
  • Iopamidol