The Clinical Study Of Contrast-induced Nephropathy In Patients With Diabetes Mellitus

Background and objectiveWith the development of diagnostic radiography and intervention medication, there is increasing interest in constrast-induced nephropathy (CIN) caused by contrast media. CIN becomes the third reason of iatrogenic acute renal failure following surgery and hypotension. Some studies discovered successful rate of PCI decreased and the risk of Q wave myocardial infarction increased and mortality rate during and after hospitalization increased for patients suffering from CIN.At present, prevention is the first step for CIN, so it is important to find out risk factors. Some studies have indicated chronic renal insufficiency (especially serum creatinine>1.5mg/dl or calculated eGFR<60ml/min/1.73m2) and diabetes mellitus complicated with chronic renal insufficiency are risk factors of CIN. But whether diabetes mellitus and renal function slightly decreasing (90ml/min/1.73m2 >eGFR≥60ml/min/1.73m2) are risk factors or not is in debate. Diabetes mellitus damages the general cardiovascular system, which cause heart and renal disease such as coronary artery disease and renal insufficiency, so patients with diabetes mellitus have more opportunity to use contrast agent and suffer from CIN. So there is important clinical value to explore the effect of contrast agent on creatinine level of diabetes mellitus patients with normal renal function or renal function slightly decreasing.Materials and methods:114 patients who went CAG and/or PCI were enrolled and eliminated patients included that evaluated glomerular filtration rate(eGFR) less than 60 ml/min/1.73m2; volume of CM more than 5ml×BW(kg)/basic SCr(mg/dl); left ventricular ejection fraction less than 35%;allergy to iodinated CM;using other iodinated CM 14 days before exposured iodinated CM;AMI patients operated primary PCI,with NTHA class IV or abnormality of hemodynamics; type I DM;renal artery stenosis (unilateral more than 70% or bilateral more than 50%) or unilateral kidney exsected;dysfunction of liver (ALT more than 120U/L);hyperthyreosis; gout.These enrolled patients were divided into two groups: DM group and non-DM group. Serum creatinine was observed before contrast exposure,24h and 72h after exposure CM to observe incidence of CIN within 72 hours.For CIN patients, SCr was observed 7days after exposure CM.Results:There was a significant difference of the CIN in two groups (8.06% vs 26.92%, P=0.011) and was not a significant difference of CIN in patient with eGFR≥90ml/min/1.73m2 and 90ml/min/1.73m2>eGFR≥60ml/min/1.73m2.CIN in non-DM groups with eGFR≥90ml/min/1.73m2 vs 90ml/min/1.73m2 >eGFR>60ml/min/1.73m2 was 8.00% vs 8.11%(P=1.000); CIN in DM groups with eGFR≥90ml/min/1.73m2 vs 90ml/min/1.73m2>eGFR≥60ml/min/1.73m2was 23.81% vs 29.03%(P=0.758). Logistic Regression analysis shows LVEF less than 50% was risk factor of CIN.Conclusion1. Diabetes mellitus is a dependent risk factor of CIN.2. Renal function slightly decreasing (90ml/min/1.73m2>eGFR≥60ml/min/1.73m2) is not a dependent risk factor of CIN.3. LVEF<50% is a dependent risk factor of CIN.