Development of Contrast-Induced Acute Kidney Injury after Elective Contrast Media Exposure in Patients with Type 2 Diabetes Mellitus: Effect of Albuminuria

• Published in: PloS one Vol. 9; no. 9; p. e106454
• Main Authors: Yang, Jun-qing, Ran, Peng, Chen, Ji-yan, He, Yi-ting, Li, Li-wen, Tan, Ning, Li, Guang, Sun, Shuo, Liu, Yong, Zhan, Jia-xin, Zheng, Jian-yi, Zhou, Ying-ling
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.09.2014; Public Library of Science (PLoS)
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Acute Kidney Injury - urine; Aged; Albuminuria - etiology; Angiography; Biology and Life Sciences; Cardiology; Catheterization; Cause of Death; Contrast agents; Contrast media; Contrast Media - adverse effects; Coronary Angiography - adverse effects; Creatinine; Demographics; Demography; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Disease prevention; Exposure; Female; Follow-Up Studies; Heart; Heart diseases; Hemodialysis; Humans; Hydration; Hydrogen ions; Incidence; Kidney transplantation; Kidneys; Male; Medicine and Health Sciences; Middle Aged; Mortality; Nonsteroidal anti-inflammatory drugs; Pathogenesis; Patient Outcome Assessment; Patients; pH effects; Regression analysis; Research and Analysis Methods; Risk analysis; Risk assessment; Risk Factors; Systematic review; Transplants & implants; Trinucleotide repeats; Urine
• DOI: 10.1371/journal.pone.0106454
• ISSN: 1932-6203

The influence of albuminuria and urinary pH on the development of contrast-induced acute kidney disease (CI-AKI) in patients with type 2 diabetes mellitus (T2DM) after elective coronary angiography (CAG) or percutaneous coronary intervention (PCI) is unknown. CI-AKI was defined as an increase in serum creatinine >26.4 µmol/L or ≥50% of baseline value within 48 hours after contrast media exposure. Demographics, traditional risk factors, clinical outcomes and CI-AKI incidence were compared between groups. Univariate analysis and multivariate logistic regression were performed to assess risk factors of CI-AKI. We observed 597 patients with T2DM after CAG or PCI. Patients were divided into 3 groups based on early morning urinary albumin: negative group (urine dipstick negative, n = 483), trace group (urine dipstick trace, n = 60), and positive group (urine dipstick ≥1+, n = 54). CI-AKI occurred in 33 (5.5%) patients, including 19 (3.9%) in the negativealbuminuria group, 4 (6.7%) in the trace group, and 10 (18.5%) in the positive group (p< 0.001), respectively. After adjusting for potential confounding risk factors, positive albuminuria (OR = 3.8, 95% CI: 1.5 to 9.2, p = 0.004) and urinary pH<6 (OR = 2.4, 95% CI: 1.1 to 5.1, p = 0.020) remained significantly associated with CI-AKI. Preprocedural albuminuria and urinary pH <6 are independent risk factors of CI-AKI in patients with T2DM undergoing elective cardiac catheterization, and may be used to identify patients at high risk of post-procedural CI-AKI.