Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy

A retrospective cohort study

Hyang Mo Koo, Fa Mee Doh, Kwang Il Ko, Chan Ho Kim, Mi Jung Lee, Hyung Jung Oh, SeungHyeok Han, Beom Seok Kim, TaeHyun Yoo, Shin-Wook Kang, Kyu Hun Choi

Research output: Contribution to journalArticle

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Abstract

Background: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN. Methods. We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA. Results: CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E' in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E' values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E' was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001). Conclusions: This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.

Original languageEnglish
Article number146
JournalBMC Nephrology
Volume14
Issue number1
DOIs
Publication statusPublished - 2013 Jul 18

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Cohort Studies
Retrospective Studies
Coronary Balloon Angioplasty
Glomerular Filtration Rate
C-Reactive Protein
Confidence Intervals
Systolic Heart Failure
Acute Kidney Injury
ROC Curve
Contrast Media
Echocardiography
Comorbidity
Creatinine
Odds Ratio
Serum

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Koo, Hyang Mo ; Doh, Fa Mee ; Ko, Kwang Il ; Kim, Chan Ho ; Lee, Mi Jung ; Oh, Hyung Jung ; Han, SeungHyeok ; Kim, Beom Seok ; Yoo, TaeHyun ; Kang, Shin-Wook ; Choi, Kyu Hun. / Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy : A retrospective cohort study. In: BMC Nephrology. 2013 ; Vol. 14, No. 1.
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title = "Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: A retrospective cohort study",
abstract = "Background: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN. Methods. We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25{\%} in serum creatinine level during the 72 hours following PTCA. Results: CIN occurred in 64 patients (8.7{\%}). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E' in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E' values of 8 and 15, CIN occurred in 42 (21.6{\%}) patients in the highest tertile compared with 20 (4.0{\%}) in the middle and 2 (4.3{\%}) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95{\%} confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E' was 0.751 (95{\%} CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001). Conclusions: This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.",
author = "Koo, {Hyang Mo} and Doh, {Fa Mee} and Ko, {Kwang Il} and Kim, {Chan Ho} and Lee, {Mi Jung} and Oh, {Hyung Jung} and SeungHyeok Han and Kim, {Beom Seok} and TaeHyun Yoo and Shin-Wook Kang and Choi, {Kyu Hun}",
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doi = "10.1186/1471-2369-14-146",
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Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy : A retrospective cohort study. / Koo, Hyang Mo; Doh, Fa Mee; Ko, Kwang Il; Kim, Chan Ho; Lee, Mi Jung; Oh, Hyung Jung; Han, SeungHyeok; Kim, Beom Seok; Yoo, TaeHyun; Kang, Shin-Wook; Choi, Kyu Hun.

In: BMC Nephrology, Vol. 14, No. 1, 146, 18.07.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy

T2 - A retrospective cohort study

AU - Koo, Hyang Mo

AU - Doh, Fa Mee

AU - Ko, Kwang Il

AU - Kim, Chan Ho

AU - Lee, Mi Jung

AU - Oh, Hyung Jung

AU - Han, SeungHyeok

AU - Kim, Beom Seok

AU - Yoo, TaeHyun

AU - Kang, Shin-Wook

AU - Choi, Kyu Hun

PY - 2013/7/18

Y1 - 2013/7/18

N2 - Background: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN. Methods. We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA. Results: CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E' in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E' values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E' was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001). Conclusions: This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.

AB - Background: Contrast-induced nephropathy (CIN) is the third leading cause of hospital-acquired acute kidney injury, and it is associated with poor long-term clinical outcomes. Although systolic heart failure is a well-known risk factor for CIN, no studies have yet evaluated the association between diastolic dysfunction and CIN. Methods. We conducted a retrospective study of 735 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and had an echocardiography performed within one month of the procedure at our institute, between January 2009 and December 2010. CIN was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% in serum creatinine level during the 72 hours following PTCA. Results: CIN occurred in 64 patients (8.7%). Patients with CIN were older, had more comorbidities, and had an intra-aortic balloon pump (IABP) placed more frequently during PTCA than patients without CIN. They showed greater high-sensitivity C-reactive protein (hs-CRP) levels and lower estimated glomerular filtration rates (eGFR). Echocardiographic findings revealed lower ejection fraction and higher left atrial volume index and E/E' in the CIN group compared with non-CIN group. When patients were classified into 3 groups according to the E/E' values of 8 and 15, CIN occurred in 42 (21.6%) patients in the highest tertile compared with 20 (4.0%) in the middle and 2 (4.3%) in the lowest tertile (p < 0.001). In multivariate logistic regression analysis, E/E' > 15 was identified as an independent risk factor for the development of CIN after adjustment for age, diabetes, dose of contrast media, IABP use, eGFR, hs-CRP, and echocardiographic parameters [odds ratio (OR) 2.579, 95% confidence interval (CI) 1.082-5.964, p = 0.035]. In addition, the area under the receiver operating characteristic curve of E/E' was 0.751 (95% CI 0.684-0.819, p < 0.001), which was comparable to that of ejection fraction and left atrial volume index (0.739 and 0.656, respectively, p < 0.001). Conclusions: This study demonstrated that, among echocardiographic variables, E/E' was an independent predictor of CIN. This in turn suggests that diastolic dysfunction may be a useful parameter in CIN risk stratification.

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U2 - 10.1186/1471-2369-14-146

DO - 10.1186/1471-2369-14-146

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