Contrast-induced nephropathy after a second percutaneous coronary intervention in patients with chronic kidney disease

Background Data are limited regarding the risk of contrast-induced nephropathy （CIN） for patients after the second contrast exposure. Objective To examine the risk of CIN after the second contrast exposure in patients of acute coronary syndrome （ACS） with chronic kidney disease （CKD）. Methods Patients of ACS scheduled for a second elective PCI. Patients were required to have an estimated creatinine clearance （CrCl） between 15 and 60 ml/min. The value of serum creatinin （sCr） prior to the second contrast exposure must not be ≥ 25% or ≥ 88.4 μmol/L compared to baseline. CIN was defined as an increase of sCr ≥ 25% from baseline within 45-72h after the second contrast exposure. The primary end-point was risk of developing CIN. Results Thirty-nine patients completed the study. The average of interval between contrast exposures was 116 ± 64 h, contrast volume was 266 ± 100 mL and length of hospitalization was 8.3 ± 4.7 days. The incidence of CIN in the overall study population was 10.3%. There was not change significantly in average sCr and CrC1 after the second contrast exposure （sCr 1.52±0.62 vs. 1.54 ± 0.60 mg/dL baseline, P = 0.75; CrC1 （40.68 ± 14.46 vs. 39.16 ± 12.10 mL/min baseline, P = 0.26）. None of the patient was death in 30 days. One （2.6%） of the patients who developed CIN required dialysis in-hospital. Conclusion Our findings suggest that patients with prior renal dysfunction are not increased risk of developing CIN after the second contrast exposure. This cohort may be benefit from sufficient prophylaxis.

Relation between pre-procedural glucose levels and incidence of major adverse cardiac events in chronic kidney disease patients without established diabetes undergoing percutaneous coronary intervention

Background It is well known that there was a significant link between preprocedural blood glucose levels and short-term and long-term adverse outcomes in patients undergoing elective PCI. However, the role of preprocedural blood glucose levels as a predictor of adverse events in CKD patients who underwent PCI out of established diabetes has acute were coronary syndrome yet to be （ACS） identified. Methods In our study, we conducted a prospective study of 331 patients with CKD who underwent PCI out of established diabetes. Patients divided into two groups based on pre-procedural glucose levels （hypoglycemia 〈 7.0 mmol/L; hyperglycemia ≥ 7.0 mmol/L）. All patients were followed up prospectively for major adverse cardiovascular events （MACEs） and mortality for 6 months. Results In our cohort, hyperglycemia patients reported a higher incidence of inhospital mortality than hypoglycemia patients （7.5% vs. 0%, P 〈 0.001）. Hyperglycemia patients reported a significantly higher rate of 6-month MACEs （10% vs. 2.4%, P = 0.007）, all cause mortality （7.5% vs. 1.6%, P = 0.015）, and cardiovascular mortality （6.2%vs 1.6%, P = 0.041） compared with hypoglycemia patients with pre-procedural glucose levels 〈 7.0 mmol/L. Multivariate analysis disclosed that a pre-procedural glucose level ≥7.0 mmol/L was a significant independent predictor of MACEs （OR = 2.53, 95% CI 1.68-17.15, P = 0.004）, all cause mortality（OR = 4.6, 95% CI 1.10-18.84, P = 0.036）, and cardiovascular mortality（OR = 6.2, 95% CI 1.53-24.94, P = 0.011） at 6 months in patients after PCI. Conclusion The study suggested that pre-procedural glucose levels are associated with short-term cardiovascular outcome CKD patients who underwent PCI without established diabetes in the setting of ACS.