Regular paperNephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose☆
Section snippets
Database and patients:
Data were obtained from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, which includes 8 academic and community hospitals in the state of Michigan participating in a multicenter registry of PCIs.13, 14, 15 The registry is part of a quality assessment and quality improvement program, and was approved by the institutional review board of the University of Michigan and by local institutional review boards. Data were prospectively collected using standardized definitions. Each
Demographics and clinical outcomes:
Data from 10,729 procedures comprised the development set; 117 patients were already on dialysis before the procedure and were excluded from the analysis. Of the remaining patients, complete baseline data were available for 9,242 patients (87.1%). The most common missing parameters were preprocedural serum creatinine (n = 1,019), total contrast dose (n = 313), and patient weight, which was necessary to calculate the MRCD and creatinine clearance (n = 48). Patients with NRD (n = 41, or 0.44%)
Discussion
Severe nephropathy requiring in-hospital dialysis following PCI is a rare complication associated with high in-hospital mortality. In a recent single center analysis of renal associated outcomes after PCI, McCullough et al4 reported an incidence of NRD of 0.21% and 0.77% in 2 consecutive data sets with an in-hospital mortality rate of 35.7% in patients developing NRD. In another series of 7,741 patients referred for PCI, the incidence of NRD was 0.66%, with an in-hospital mortality rate of
References (30)
- et al.
The American College of Cardiology/American Heart Association guidelines for coronary angiographya report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on Coronary Angiography)
J Am Coll Cardiol
(1999) - et al.
The American College of Cardiology/American Heart Association guidelines for percutaneous transluminal coronary angioplastya report of the American College of Cardiology/American Heart Association task force on assessment of diagnostic and therapeutic cardiovascular procedures (Committee on Percutaneous Transluminal Coronary Angioplasty)
J Am Coll Cardiol
(1993) - et al.
Acute renal failure after coronary interventionIncidence, risk factors and relationship to mortality
Am J Med
(1997) - et al.
A prospective randomized trial of prevention in patients at high risk for contrast nephropathy. Results of the PRINCE studyPrevention of Radiocontrast Induced Nephropathy Clinical Evaluation
J Am Coll Cardiol
(1999) - et al.
Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with pre-existing renal insufficiency
Am J Cardiol
(1999) - et al.
The prognostic implications of further renal function deterioration within 48 hours of interventional coronary procedures in patients with pre-existent chronic renal insufficiency
J Am Coll Cardiol
(2000) - et al.
Independent association between acute renal failure and mortality following cardiac surgery
Am J Med
(1998) - et al.
The American College of Cardiology/American Heart Association guidelines for coronary artery bypass graft surgerya report of the American College of Cardiology/American Heart Association task force on practice guidelines
J Am Coll Cardiol
(1999) - et al.
Differential survival after coronary revascularization procedures among patients with renal insufficiency
Kidney Int
(2001) Contrast-associated nephropathy. presentation, pathophysiology and management
Miner Electrolyte Metab
(1994)
The effect of acute renal failure on mortalitya cohort analysis
JAMA
Acute renal failure in intensive care units—causes, outcome, and prognostic factors of hospital mortalitya prospective, multi-center study (French Study Group on Acute Renal Failure)
Crit Care Med
Prognostic stratification in critically ill patients with acute renal failure requiring dialysis
Arch Int Med
Acute renal failure requiring dialysis after percutaneous coronary interventions
Catheter Cardiovasc Interv
Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents
N Engl J Med
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This study was supported by a grant from the Blue Cross Blue Shield of Michigan Foundation, Detroit, Michigan.