Comparison of risk factors for contrast-induced acute kidney injury between patients with and without diabetes.

Although it is well known that diabetics are at a higher risk of contrast-induced acute kidney injury (CI-AKI) than nondiabetic patients, the reason for this discrepancy is not well known. Thus, in this study, we compared the predisposing factors for CI-AKI between patients with and without diabetes. We prospectively studied 290 consecutive in-hospital patients including 88 diabetics undergoing coronary angiography or a percutaneous coronary intervention in Kowsar hospital, and we compared risk factors for CI-AKI between diabetic and nondiabetic patients. CI-AKI was defined as RIFLE criteria within 48 hours after contrast exposure. The incidence of CR-AKI was significantly higher in diabetic patients compared with nondiabetics (P<0.05). The incidence of CI-AKI was significantly higher in patients with diabetes and left-ventricular ejection fraction ≤40%, hypercholesterolemia, serum creatinine ≥1.1 mg/dL, estimated glomerular filtration rate (eGFR) <90 mL/min, Contrast volume ≥80 (mL), maximum safe contrast volume factor of 1.5, and dehydration, while in nondiabetics, a significantly higher incidence of CR-AKI was observed in those with serum creatinine ≥1.1 mg/dL (P=0.02) and/or eGFR<60 mL/min (P=0.01). Multiple logistic regression analysis showed hyperchlosteremia to be the strongest predictor of AKI (P=0.01, B:14.5) in diabetics, followed by eGFR<90 (P=0.05, B:12.4) but, in nondiabetics, only eGFR<60 predicted the occurrence of CI-AKI (P=0.04, B:2.3). It seems that the predisposing factors to CI-AKI differ in diabetics and nondiabetics. In patients with diabetes, hypercholesterolemia is the strongest predictor of CI-AKI, followed by eGFR and diabetics are at risk for CI-AKI in the early stage of chronic kidney disease (stage 2), accounting for the higher incidence of CI-AKI in them.

Risk Factors for contrast-related acute kidney injury according to risk, injury, failure, loss, and end-stage criteria in patients with coronary interventions.

INTRODUCTION: Although a series of risk factors for contrast-induced nephropathy are known, data on significance of some of the risk factors such as age, sex, hypercholesterolemia, hyperuricemia, and dose of contrast medium are inconsistent. Our aim was to identify risk factors for contrast-related acute kidney injury (AKI). MATERIALS AND METHODS: In this prospective study, 290 consecutive patients with a serum creatinine level lower than 3 mg/dL undergoing percutaneous angiography were analyzed. Contrast-related AKI was evaluated using the risk, injury, failure, loss, and end-stage (RIFLE) criteria, and its correlation with clinical and laboratory data of the patients was analyzed. RESULTS: Contrast-related AKI was found in 15.5% of the patients, with a maximum RIFLE category (risk in 13.8%, injury in 1.4%, and failure in 0.3%). Serum creatinine level, contrast volume, safe contrast volume factor, diabetes mellitus, and dehydration were significantly associated with contrast-related AKI. Age, sex, and serum uric acid level did not differ significantly between those with and without contrast-related AKI. Multiple logistic regression analysis disclosed diabetes mellitus to be the strongest predictor for being at risk of contrast-related AKI (odds ratio, 5.1; 95% confidence interval, 1.9 to 11.0; P = .001), followed by hypercholesterolemia (odds ratio, 4.6; 95% confidence interval, 1.1 to 8.3; P = .03), and an estimated glomerular filtration rate lower than 90 mL/min/1.73 m2 (odds ratio, 3.0; 95% confidence interval, 1.8 to 5.7; P = .003). CONCLUSIONS: Our results indicate that diabetes mellitus, hypercholesterolemia, and underlying chronic kidney disease are the major factors of contrast-related AKI.