Clinical Study Of Contrast Medium-induced Acute Kidney Injury In Patients Undergoing Coronary Intervention

Contrast medium–induced acute kidney injury (CI-AKI) is a well-knowncomplication in patients with chronic renal insufficiency undergoingcoronary angiography or interventions. CI-AKI is a significant problem inclinical practice, but also one that is often unrecognized. In12%of cases, it isthe third leading cause of hospital-acquired acute renal failure and isassociated with36%mortality in patients who require in-hospital dialysis with19%survival at2years.The estimated incidence of CI-AKI after coronaryangiography was around0-50%.Through this study, we evaluated the incident of CI-AKI in generalpatients undergoing coronary angiographically diagnostic and therapeuticprocedure and the risk of CI-AKI. We also evaluated the efficacy oftrimadazion in the prevention of CI-AKI in patients at risk undergone cardiaccatheterization.Part1Incidence and risk factors of Contrastmedium–induced acutekidney injury in patients undergoing coronary intervention: aprospective studyObjective: To evaluate the incident of CI-AKI in general patientsundergoing coronary angiographically diagnostic and therapeutic procedureand the risk of CI-AKI.Method: This was a single center, prospective study. Between December2011and December2012, in patients underwent coronary intervention in theThe Third Hospital of Hebei Medical University, a total of620patients wereenrolled. Age, sex, body weight, comorbidities (including hypertension,Coronary heart disease, renal insufficiency, heart failure, diabetes mellitus,and anemia), use of drug(including metformin, angiotensin converting enzymeinhibitors（ACEI）, diuretics, and volume of Contrast-meida used were documented. Serum creatinine （Scr）, blood glucose, Triglyceride, leftventricular ejection fraction also were documented. All of the patients werepunctured radial artery or femoral artery through the method called Seldingerand Coronary angiography with Judkins. All of the contrast media wasLow-osmolality nonionic. Serum creatinine（Scr）was measure before theangiography and24hours,48hours post procedure to judge if CI-AKIoccurred or not. Contrast medium–induced kidney injury was defined as anincrease in serum creatinine25%or0.5mg/dL（44.2μmol/L） above baselineat48hours after contrast medium exposure.Result：1Among the all620patients,415（66.9%）were male and205（33.1%）were female. The average age was60.34±11.54years old, and there were135people above75years. Among the patients enrolled,532(85.8%) had coronaryartery heart disease,148(23.9%)had diabetes mellitus,14（2.6%）had acutehyperglycemia,523(84.3%) had hypertension, had heart failure, and anemiaexisted in35(5.6%). The average Scr before procedure was70.06±19.63umol/L. The average volume of contrast media was215±103.4ml,145and45patients took ACEI and diuretics respectively.38(6.1%) took metformin.2Among the620patients, CI-AKI occurred in18patients with theincidence of CI-AKI in gerenal patients of2.9%.3The Analysis of the Risk factors: Volume of contrast-media more than500ml, renal failure, diabetes, acute hyperglycemia, and hypertension were theunivariatde risk factors of CI-AKI. Using logistics regression, renal failure,acute hyperglycemia were the independent risk factors of CI-AKI.Conclusion:1Among the620patients, CI-AKI occurred in18patients with theincidence of CI-AKI in gerenal patients of2.9%.2Renal failure, acute hyperglycemia were the independent risk factors ofCI-AKI.3Volume of contrast-media more than500ml, diabetes, and hypertensionwere the univariatde risk factors of CI-AKI. Part2Trimetazidine in the prevention of contrast-induced nephropathyafter coronary proceduresObjective: To evaluate the efficacy of trimadazion in the prevention ofCI-AKI in patients at risk undergone cardiac catheterization.Method:148patients who underwent percutaneous coronaryintervention with coronary heart disease and diabetes were divided intoreceive the Trimetazidine group or the control group. Age, sex, body weight,comorbidities(including hypertension, diabetes mellitus, renal insufficiency,and anemia), eGFR and volume of Contrast-meida used were documented.Serum creatinine levels were measured before the procedure,24h,48h and7days after the procedure. All patients were given intravenous saline (0.9%) at arate of1.0~1.5ml/kg of body weight per hour form3~12h before theoperating and continued until afeter angiography or PCI for6~24h.At thesame time, encouraged drinking water quantity not less than1200ml after theperation. Excepted for the foundation treatment of coronary heart disease,among the TMZ group treated with trimetazidine plus hydration with normalsaline and control group given hydration by normal saline only. TMZ (20mgthrice daily) was administered orally for72h starting48h before theprocedure. One week postoperative continuoued. Observed the change of Scrand the occurrence of cardiovascular events. The primary endpoint was thechange in Scr after contrast. Secondary endpoints included the development ofCI-AKI.Result: From two groups SCr peak in terms of the changed, the TMZgroup was lower than the control group team(11.3±4.3umol/L vs26.9±6.8umol/L）, and it was statistically significant difference(P=0.04). Amongthe148patients,3patients developed CI-AKI and the incidence of CI-AKIwas2%. Among them1patient in TMZ group, and2patients in control group.The TMZ group was lower than the control group team, but it was nostatistically significant difference(1.3%vs2.8%,χ2=1.653，P=0.396).Conclusion:TMZ along with isotonic saline infusion was more effective than isotonic saline alone in reducing the risk of CI-AKI in patients with pre-existing renaldysfunction.