Abstract

Research Article

Left ventricular ejection fraction and contrast induced acute kidney injury in patients undergoing cardiac catheterization: Results of retrospective chart review

Firas Ajam*, Obiora Maludum, Nene Ugoeke, Hetavi Mahida, Anas Alrefaee, Amy Quinlan DNP, Jennifer Heck-Kanellidis NP, Dawn Calderon DO, Mohammad A Hossain* and Arif Asif

Published: 15 November, 2019 | Volume 4 - Issue 3 | Pages: 195-198

Background: Contrast-induced acute kidney injury (CI-AKI) is an important cause of increasing the hospital stay and in-hospital mortality. By increasing intra-renal vasoconstriction, left ventricular ejection fraction (LVEF) can increase the risk of CI-AKI. We sought to investigate whether LVEF can impact the incidence of CI-AKI after cardiac catheterization and whether it can be used to predict CI-AKI.

Methods: Patients underwent cardiac catheterization from December 2017 to February 2018 at Jersey Shore University Medical Center were enrolled in the study. Contrast-induced acute kidney injury (CI-AKI) was defined as an increase in serum creatinine of ≥ 0.5 mg/dL or an increase of ≥ 25% from the pre-procedure value within 72 hours post-procedure. The maximum allowable contrast dose was calculated using the following formula: (5* (weight (kg)/creatinine level (mg/dL)). A multivariable logistic regression analyses, controlling for potential confounders, were used to test associations between LVEF and CI-AKI.

Results: 9.6% had post catheterization CI-AKI. A total of 18 out of 44 (44%) of patients who had CI-AKI also had ongoing congestive heart failure. No statistically significant association found neither with maximum allowable contrast (p = 0.009) nor ejection fraction (p = 0.099) with the development of CI-AKI.

Conclusion: In spite of the fact that no statistically significant relationship found between the percentage maximum contrast dose and the ejection fraction with the post-procedure CI-AKI, we heighten the essential of employing Maximum Allowable Contrast Dose (MACD) and ejection fraction in patients undergoing PCI to be used as a clinical guide to predict CI-AKI.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001066 Cite this Article Read Full Article PDF

Keywords:

Contrast nephropathy; Left ventricular ejection fraction; Acute kidney injury

References

  1. Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC CardiovascInterv. 2014; 7: 1-9. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24456715
  2. Weisbord SD, Palevsky PM. Contrast-induced acute kidney injury: short and long-term implications. Semin Nephrol. 2011; 31: 300-309. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21784279
  3. Pakfetrat M, Malekmakan L, Zahra Salmanpour, Mohammad Hossein Nikoo, Peyman Izadpanah, Comparison of Normal Saline, Ringer's Lactate, and Sodium Bicarbonate for Prevention of Contrast-induced Nephropathy in Patients with Coronary Angiography: A Randomized Double-blind Clinical Trial. Indian J Nephrol. 2019; 29: 22-27. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375023/
  4. Wang K, Li HL, Bei WJ, Guo XS, Chen SQ, et al. Association of left ventricular ejection fraction with contrast-induced nephropathy and mortality following coronary angiography or intervention in patients with heart failure. Ther Clin Risk Manag. 2017; 13: 887-895. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28769566
  5. Brown JR, Robb JF, Block CA, Schoolwerth AC, Kaplan AV, et al. Does safe dosing of iodinated contrast prevent contrast-induced acute kidney injury?. Circ Cardiovasc Interv. 2010; 3: 346-350. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20587788
  6. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002; 39: 930-936. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11979336
  7. Wong PCY, Li Z, Guo J, Zhang A. Pathophysiology of contrast-induced nephropathy. Int J Cardiol. 2012; 158: 186-192. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21784541
  8. Caiazza, A, Russo L, Sabbatini, M, Russo D. Hemodynamic and Tubular Changes Induced by Contrast Media. BioMed Research International, 2014; 1-7.
  9. Hossain MA, Costanzo E, Cosentino J, Patel C, Qaisar H, et al. Contrast-induced nephropathy: Pathophysiology, risk factors, and prevention. Saudi J Kidney Dis Transpl. 2018; 29:1-9. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29456202
  10. Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004; 44:1393-1399. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15464318
  11. Flint N, Kaufman N, Gal-Oz A, Margolis G, Topilsky Y, et al. Echocardiographic correlates of left ventricular filling pressures and acute cardio-renal syndrome in ST segment elevation myocardial infarction patients. Clin Res Cardiol. 2017; 106: 20-126. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27550512
  12. Cigarroa RG, Lange RA, Williams RH, Hillis LD. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med. 1989; 86: 649-652. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2729314
  13. Freeman RV, O'Donnell M, Share D, Meengs WL, Kline-Rogers E, et al. Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. The American journal of cardiology. 2002; 90:1068-1073. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12423705
  14. Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002; 105: 2259-2264. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12010907
  15. Grams ME, Sang Y, Ballew SH, Gansevoort RT, Kimm H, Kovesdy CP, et al. A meta-analysis of the association of estimated GFR, albuminuria, age, race, and sex with acute kidney injury. American Journal of Kidney Diseases. 2015; 66: 591-601. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25943717
  16. Chang JW, Jeng MJ, Yang LY, Chen TJ, Chiang SC, et al. The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan. Kidney International. 2015; 87: 632-639. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25252027
  17. Chawla LS, Eggers PW, Star RA, Kimmel PL. Acute kidney injury and chronic kidney disease as interconnected syndromes. The New England Journal of Medicine. 2014; 371: 58-66. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24988558
  18. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. kdigo clinical practice guideline for acute kidney injury. Kidney International Supplements. 2012; 2: 1-138.

Figures:

Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?