Incidence, Risk Factors And Prognosis For Iodinated Contrast-induced Nephropathy In Patient After Interventional Diagnosis And Treatment

Background:At present, the most common accepted criteria for Contrast induced nephrology (CIN) were formulated by European Society of Urogenital Radiology (ESUR) and Kidney Disease:Improving Global Outcomes (KDIGO). But a prospective study should be conduct to make sure which criteria is more suitable for clinical settings. Whether serum Cystatin C (CysC) is a superior predictor to Scr for diagnosis of CIN is still controversial.Objective:To compare sensitivity and diagnostic specificity of serum creatinine and CysC for early CIN prediction in patients undergoing angiography and to investigate difference of the incidence, risk factors, in-hospital and3-month prognosis of CIN according to serum CysC criteria and Scr criteria (ESUR criteria and KDIGO criteria).Methods:We prospectively evaluated213patients undergoing angiography and/or intervention therapy from April2011to October2011in vascular intervention ward of the Second Xiangya Hospital of Central South University. We compared the incidence, risk factors, in-hospital and3-month prognosis of CIN according to the diagnostic criteria of Scr (ESUR and KDIGO criteria) and serum CysCResults:1. The incidence of CIN varied from4.2%to24.4%according to serum CysC and Scr diagnostic criteria.2. Chronic kidney disease, diabetes mellitus, hypercholesterolemia, dehydration and hypoalbuminemia were independent risk factors for CIN.3. According to ESUR criteria, area under the ROC curve of Scr48h after procedure was equal to serum CysC (0.790vs0.715, p=0.178). While using KDIGO criteria, area under the ROC curve of Scr48h after procedure was superior to serum CysC (0.972vs0.856, p=0.006).4. The3-month mortality in CIN group was higher than that in non-CIN group according to ESUR criteria and KDIGO criteria, respectively (p<0.05). But there was no significant difference about3-month mortality between CIN group and non-CIN group according to the serum CysC criteria (p>0.05).Conclusion:The incidence of CIN was related to diagnostic criteria. The serum CysC is not superior to Scr for predicting CIN in patients undergoing angiography and/or intervention therapy. ESUR criteria seemed more sutiable for diagnosis of CIN in patients undergoing angiography and/or intervention therapy. Chronic kidney disease, diabetes mellitus, hypercholesterolemia dehydration and hypoalbuminemia were independent risk factors for CIN. CIN is associated with3-month mortality after angiography and/or intervention therapy.