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Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study

Authors
 Hyang Mo Koo  ;  Fa Mee Doh  ;  Kwang Il Ko  ;  Chan Ho Kim  ;  Mi Jung Lee  ;  Hyung Jung Oh  ;  Seung Hyeok Han  ;  Beom Seok Kim  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Kyu Hun Choi 
Citation
 BMC NEPHROLOGY, Vol.14 : 146, 2013 
Journal Title
 BMC NEPHROLOGY 
Issue Date
2013
MeSH
Acute Kidney Injury/chemically induced* ; Acute Kidney Injury/diagnostic imaging* ; Acute Kidney Injury/epidemiology ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary/adverse effects* ; Cohort Studies ; Contrast Media/adverse effects* ; Female ; Follow-Up Studies ; Heart Failure, Diastolic/diagnostic imaging* ; Heart Failure, Diastolic/epidemiology ; Humans ; Male ; Middle Aged ; ROC Curve ; Retrospective Studies ; Risk Factors ; Ultrasonography
Keywords
Acute Kidney Injury/chemically induced* ; Acute Kidney Injury/diagnostic imaging* ; Acute Kidney Injury/epidemiology ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary/adverse effects* ; Cohort Studies ; Contrast Media/adverse effects* ; Female ; Follow-Up Studies ; Heart Failure, Diastolic/diagnostic imaging* ; Heart Failure, Diastolic/epidemiology ; Humans ; Male ; Middle Aged ; ROC Curve ; Retrospective Studies ; Risk Factors ; Ultrasonography
Abstract
BACKGROUND: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN. METHODS: We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA. RESULTS: CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E' in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E' values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E' was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001). CONCLUSIONS: This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.
Files in This Item:
T201302638.pdf Download
DOI
10.1186/1471-2369-14-146
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Koo, Hyang Mo(구향모)
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Kim, Chan Ho(김찬호)
Doh, Fa Mee(도화미) ORCID logo https://orcid.org/0000-0002-4780-6728
Oh, Hyung Jung(오형중)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Mi Jung(이미정)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87498
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