The Risk Of Contrast-induced Nephropathy Following Chronic Total Occlusion In Patients With Chronic Kidney Disease

Objective:To discuss the risk of patients who undergoing percutaneous coronary intervention for chronic total occlusion combined with chronic kidney disease developed contrast-induced nephropathy. And to investigate the risk factors for contrast-induced nephropathy.Methods:During 1st January 2015 to 30th September 2015,199 patients with chronic kidney disease in the Department of Cardiology, Sir Run Run Shaw hospital were enrolled with this study. Patients were divided into three groups:patients who underwent attempted PCI for CTO (group A, n=54), patients who did not receive PCI for CTO (group B, n=18) and patients without CTO (group C, n=127). The endpoints of the study were the occurrence of contrast-induced nephropathy or major adverse cardiovascular events (MACE) in hospital. Discussing the risk of patients combined with CKD and CTO developed contrast-induced nephropathy.Results:Among the 199 patients, the number of attempted to achieve recanaliztion of CTO was 54(group A), of patients who underwent PCI for other vessels was 18(group B), of patients without CTO was 127(group C). The clinical baseline characters between 3 groups were no significantly different. Number of patient who developed postoperative contrast-induced nephropathy was 9, accounting for 4.5% in whole patients. The occurrence of CIN between 3 groups was no significant difference. There were significant differences (p=0.019) of preoperative hydration between group A and C. Periprocedural hydration and the type of contrast media between 3 groups had no significant difference. Multivariate analysis of risk predictors for contrast-induced nephropathy showed that periprocedural fasting blood glucose was closely related to the occurrence of CIN (P=0.006, OR=1.144). However, diabetes was not the related risk predictor during our study.Conclusion:Recanalization of CTO in patients with CKD may not increase the rate of occurrence of CIN, in-hospital death, hemodialysis and acute heart failure. Control the levels of blood glucose during the periprocedural time may decrease the risk of CIN.