Contrast-induced acute kidney injury in chronic coronary artery disease patients with diabetes mellitus and obesity
- Authors: Mironova O.I.1, Staroverov I.I.2, Sivakova O.A.2, Deev A.D.3, Fomin V.V.1
-
Affiliations:
- Sechenov First Moscow State Medical University (Sechenov University)
- National Medical Research Center of Cardiology
- National Research Center for Preventive Medicine
- Issue: Vol 92, No 10 (2020)
- Pages: 29-33
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/50972
- DOI: https://doi.org/10.26442/00403660.2020.10.000753
- ID: 50972
Cite item
Full Text
Abstract
Aim. To assess the influence of diabetes mellitus and obesity on contrast-induced acute kidney injury risk in patients with chronic coronary artery disease requiring percutaneous coronary intervention.
Materials and methods. 1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). Contrast-induced acute kidney injury was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The majority of the patients were overweight male ones with BMI 29.2±5.5 kg/m2. The primary endpoint of the study was the development of contrast-induced acute kidney injury according to KDIGO criteria.
Results. The prevalence of contrast-induced acute kidney injury was 12.9% (132 patients). 21.2% suffered from diabetes mellitus, 43% were obese and 12.9% had both diabetes mellitus and obesity. Diabetes wasn’t a statistically significant independent risk factor of the contrast-induced acute kidney injury, as well as the combination of diabetes and obesity. In the group of obese patients the prevalence of contrast-induced acute kidney injury was higher (13.4% vs 12.5%), but didn’t meet statistical significance (p=0.7, OR 0.924, 95% CI 0.64–1.325). According to the multiple logistic regression model, female gender, age, BMI, weight, arterial hypertension, baseline creatinine were the risk factors of the contrast-induced acute kidney injury development (AUC 0.742, p<0.0001).
Conclusion. Diabetes mellitus was not associated with higher incidence of contrast-induced acute kidney injury. The prevalence of contrast-induced kidney injury was higher in the group of patients with BMI≥30 kg/m2, but didn’t meet statistical significance and needs further evaluation in larger studies.
Full Text
##article.viewOnOriginalSite##About the authors
O. Iu. Mironova
Sechenov First Moscow State Medical University (Sechenov University)
Author for correspondence.
Email: mironova_o_yu@staff.sechenov.ru
ORCID iD: 0000-0002-5820-1759
к.м.н., доц. каф. факультетской терапии №1 Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)
Russian Federation, MoscowI. I. Staroverov
National Medical Research Center of Cardiology
Email: mironova_o_yu@staff.sechenov.ru
ORCID iD: 0000-0002-0049-6101
д.м.н., рук. отд. неотложной кардиологии ФГБУ «НМИЦ кардиологии»
Russian Federation, MoscowO. A. Sivakova
National Medical Research Center of Cardiology
Email: mironova_o_yu@staff.sechenov.ru
ORCID iD: 0000-0002-0060-095X
к.м.н., зав. отд-нием артериальной гипертонии ФГБУ «НМИЦ кардиологии»
Russian Federation, MoscowA. D. Deev
National Research Center for Preventive Medicine
Email: mironova_o_yu@staff.sechenov.ru
ORCID iD: 0000-0002-7669-9714
к.ф.-м.н., вед. науч. сотр. отд. эпидемиологии хронических неинфекционных заболеваний ФГБУ «НМИЦ терапии и профилактической медицины»
Russian Federation, MoscowV. V. Fomin
Sechenov First Moscow State Medical University (Sechenov University)
Email: mironova_o_yu@staff.sechenov.ru
ORCID iD: 0000-0002-2682-4417
чл.-кор. РАН, д.м.н., проф., проректор по клинической работе и дополнительному профессиональному образованию, зав. каф. факультетской терапии №1 Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)
Russian Federation, MoscowReferences
- Mehta RL, Cerdá J, Burdmann EA, et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): A human rights case for nephrology. Lancet. 2015;385(9987):2616-43. doi: 10.1016/S0140-6736(15)60126-X
- Colwell JA, Lopes-Virella M, Halushka PV. Pathogenesis of Atherosclerosis in Diabetes Mellitus. Diabetes Care. 1981;4(1):121. http://care.diabetesjournals.org/content/4/1/121.abstract
- Barrett-connor EL, Diego S. Obesity. Atherosclerosis, and Coronary Artery Disease. Ann Intern Med. 1985;103:1010-9. doi: 10.7326/0003-4819-103-6-1010
- Matsuda M, Shimomura I. Increased oxidative stress in obesity: Implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Obes Res Clin Pract. 2013;7(5):1-12. doi: 10.1016/j.orcp.2013.05.004
- Calvin AD, Misra S, Pflueger A. Contrast-induced acute kidney injury and diabetic nephropathy. Nat Rev Nephrol. 2010;6(11):679-88. doi: 10.1038/nrneph.2010.116
- Pakfetrat M, Nikoo MH, Malekmakan L, et al. Comparison of risk factors for contrast-induced acute kidney injury between patients with and without diabetes. Hemodial Int 2010;14(4):387-92. doi: 10.1111/j.1542-4758.2010.00469.x
- Ma M, Wan X, Gao M, et al. Renin-angiotensin-aldosterone system blockade is associated with higher risk of contrast-induced acute kidney injury in patients with diabetes. Aging (Albany NY). 2020;12(7):5858-77. doi: 10.18632/aging.102982
- Zeng J-F, Chen S-Q, Ye J-F, et al. A simple risk score model for predicting contrast-induced nephropathy after coronary angiography in patients with diabetes. Clin Exp Nephrol. 2019;23(7):969-81. doi: 10.1007/s10157-019-01739-0
- Шамхалова М.Ш., Зайцева Н.В., Курумова К.О. и др. Контрастиндуцированная нефропатия при коронарографии у больных сахарным диабетом 2-го типа: факторы риска развития, прогностическая значимость, пути профилактики. Терапевтический архив. 2009;81(8):36-42 [Shamkhalova MS, Zaytseva NV, Kurumova KO, et al. Contrast-inducible nephropathy in coronarography in patients with type 2 diabetes mellitus: risk factors, prognostic significance, prophylactic approaches. Therapeutic Archive. 2009;81(8):36-42 (In Russ.)].
- Шестакова М.В., Шамхалова М.Ш., Ярек-Мартынова И.Я. и др. Сахарный диабет и хроническая болезнь почек: достижения, нерешенные проблемы и перспективы лечения. Сахарный диабет. 2011;1:81-8 [Shestakova MV, Shamkhalova MSh, Yarek-Martynova IYa, et al. Diabetes mellitus and chronic kidney disease: achievements, unresolved problems, and prospects for therapy. Diabetes mellitus. 2011;1:81-8 (In Russ.)]. doi: 10.14341/2072-0351-6254
- Jaipaul N, Manalo R, Sadjadi S-A. Obesity is not associated with contrast nephropathy. Ther Clin Risk Manag. 2010;213. doi: 10.2147/tcrm.s10198
- Kumar AB, Bridget Zimmerman M, Suneja M. Obesity and post-cardiopulmonary bypass-associated acute kidney injury: A single-center retrospective analysis. J Cardiothorac Vasc Anesth. 2014;28(3):551-6. doi: 10.1053/j.jvca.2013.05.037
- O’Sullivan KE, Byrne JS, Hudson A, et al. The effect of obesity on acute kidney injury after cardiac surgery. J Thorac Cardiovasc Surg. 2015;150(6):1622-8. doi: 10.1016/j.jtcvs.2015.08.082
- KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):3. https://linkinghub.elsevier.com/retrieve/pii/ S2157171615310406
- Toprak O, Cirit M, Yesil M, et al. Impact of diabetic and pre-diabetic state on development of contrast-induced nephropathy in patients with chronic kidney disease. Nephrol Dial Transplant. 2007;22(3):819-26. doi: 10.1093/ndt/gfl636
- Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. Kidney Int. 1995;47(1):254-61. doi: 10.1038/ki.1995.32
- Rudnick MR, Goldfarb S, Tumlin J. Contrast-induced nephropathy: Is the picture any clearer? Clin J Am Soc Nephrol. 2008;3(1):261-2. doi: 10.2215/CJN.04951107
- Grams ME, Sang Y, Ballew SH, et al. A meta-analysis of the association of estimated GFR, albuminuria, age, race, and sex with acute kidney injury. Am J Kidney Dis. 2015;66(4):591-601. doi: 10.1053/j.ajkd.2015.02.337
- Marenzi G, De Metrio M, Rubino M, et al. Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention. Am Heart J. 2010;160(6):1170-7. doi: 10.1016/j.ahj.2010.09.022
- Кобалава Ж.Д., Виллевальде С.В., Ефремовцева М.А. Кардиоренальные взаимодействия при декомпенсации хронической сердечной недостаточности. Рациональная фармакотерапия в кардиологии. 2016;12(2):138-46 [Kobalava ZD, Villevalde SV, Efremovtseva MA. Cardiorenal interaction in decompensated chronic heart failure. Rational Pharmacotherapy in Cardiology. 2016;12(2):138-46 (In Russ.)]. doi: 10.20996/1819-6446-2016-12-2-138-146
- Rear R, Bell RM, Hausenloy DJ. Contrast-induced nephropathy following angiography and cardiac interventions. Heart. 2016;102(8):638-48. doi: 10.1136/heartjnl-2014-306962