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Studies have substantiated greater all-cause and cardiovascular mortality<ref name="pmid15519007">{{cite journal| author=Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I et al.| title=Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. | journal=J Am Coll Cardiol | year= 2004 | volume= 44 | issue= 9 | pages= 1780-5 | pmid=15519007 | doi=10.1016/j.jacc.2004.07.043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15519007 }} </ref>, prolonged duration of hospitalization<ref name="pmid14668704">{{cite journal| author=McCullough PA, Sandberg KR| title=Epidemiology of contrast-induced nephropathy. | journal=Rev Cardiovasc Med | year= 2003 | volume= 4 Suppl 5 | issue= | pages= S3-9 | pmid=14668704 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14668704 }} </ref>, and late cardiovascular events<ref name="pmid16949375">{{cite journal| author=McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F et al.| title=Epidemiology and prognostic implications of contrast-induced nephropathy. | journal=Am J Cardiol | year= 2006 | volume= 98 | issue= 6A | pages= 5K-13K | pmid=16949375 | doi=10.1016/j.amjcard.2006.01.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16949375 }} </ref> associated with CIN. The evidence is seen mostly in patients undergoing PCI.<ref name="pmid18802377">{{cite journal| author=McCullough PA| title=Radiocontrast-induced acute kidney injury. | journal=Nephron Physiol | year= 2008 | volume= 109 | issue= 4 | pages= p61-72 | pmid=18802377 | doi=10.1159/000142938 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18802377 }} </ref><ref name="pmid16928802">{{cite journal| author=Weisbord SD, Chen H, Stone RA, Kip KE, Fine MJ, Saul MI et al.| title=Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. | journal=J Am Soc Nephrol | year= 2006 | volume= 17 | issue= 10 | pages= 2871-7 | pmid=16928802 | doi=10.1681/ASN.2006030301 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16928802 }} </ref> Weisbord et al showed that an absolute increase in serum creatinine of 0.25 to 0.5 mg/dL within 72 hours after coronary angiography was associated with significantly greater odds for in-hospital mortality in the 30 day period following the procedure.<ref name="pmid16928802">{{cite journal| author=Weisbord SD, Chen H, Stone RA, Kip KE, Fine MJ, Saul MI et al.| title=Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. | journal=J Am Soc Nephrol | year= 2006 | volume= 17 | issue= 10 | pages= 2871-7 |pmid=16928802 | doi=10.1681/ASN.2006030301 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16928802 }} </ref> The need for dialysis following CIN is also a separate prognostic indicator. Dialysis requirement has been associated with a fivefold increase in all-cause mortality when compared to patients with CIN not requiring renal replacement. Furthermore, mortality in the former group was as high as 81% at 2 years.<ref name="pmid9375704">{{cite journal| author=McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW| title=Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. | journal=Am J Med | year= 1997 | volume= 103 | issue= 5 | pages= 368-75 | pmid=9375704 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9375704 }} </ref> Several of the studies targeting prognosis following CIN have been limited by the confounding factors mostly because high risk patients for CIN are naturally at higher risk for cardiovascular complications. | Studies have substantiated greater all-cause and cardiovascular mortality<ref name="pmid15519007">{{cite journal| author=Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I et al.| title=Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. | journal=J Am Coll Cardiol | year= 2004 | volume= 44 | issue= 9 | pages= 1780-5 | pmid=15519007 | doi=10.1016/j.jacc.2004.07.043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15519007 }} </ref>, prolonged duration of hospitalization<ref name="pmid14668704">{{cite journal| author=McCullough PA, Sandberg KR| title=Epidemiology of contrast-induced nephropathy. | journal=Rev Cardiovasc Med | year= 2003 | volume= 4 Suppl 5 | issue= | pages= S3-9 | pmid=14668704 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14668704 }} </ref>, and late cardiovascular events<ref name="pmid16949375">{{cite journal| author=McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F et al.| title=Epidemiology and prognostic implications of contrast-induced nephropathy. | journal=Am J Cardiol | year= 2006 | volume= 98 | issue= 6A | pages= 5K-13K | pmid=16949375 | doi=10.1016/j.amjcard.2006.01.019 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16949375 }} </ref> associated with CIN. The evidence is seen mostly in patients undergoing PCI.<ref name="pmid18802377">{{cite journal| author=McCullough PA| title=Radiocontrast-induced acute kidney injury. | journal=Nephron Physiol | year= 2008 | volume= 109 | issue= 4 | pages= p61-72 | pmid=18802377 | doi=10.1159/000142938 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18802377 }} </ref><ref name="pmid16928802">{{cite journal| author=Weisbord SD, Chen H, Stone RA, Kip KE, Fine MJ, Saul MI et al.| title=Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. | journal=J Am Soc Nephrol | year= 2006 | volume= 17 | issue= 10 | pages= 2871-7 | pmid=16928802 | doi=10.1681/ASN.2006030301 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16928802 }} </ref> Weisbord et al showed that an absolute increase in serum creatinine of 0.25 to 0.5 mg/dL within 72 hours after coronary angiography was associated with significantly greater odds for in-hospital mortality in the 30 day period following the procedure.<ref name="pmid16928802">{{cite journal| author=Weisbord SD, Chen H, Stone RA, Kip KE, Fine MJ, Saul MI et al.| title=Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography. | journal=J Am Soc Nephrol | year= 2006 | volume= 17 | issue= 10 | pages= 2871-7 |pmid=16928802 | doi=10.1681/ASN.2006030301 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16928802 }} </ref> The need for dialysis following CIN is also a separate prognostic indicator. Dialysis requirement has been associated with a fivefold increase in all-cause mortality when compared to patients with CIN not requiring renal replacement. Furthermore, mortality in the former group was as high as 81% at 2 years.<ref name="pmid9375704">{{cite journal| author=McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW| title=Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. | journal=Am J Med | year= 1997 | volume= 103 | issue= 5 | pages= 368-75 | pmid=9375704 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9375704 }} </ref> Several of the studies targeting prognosis following CIN have been limited by the confounding factors mostly because high risk patients for CIN are naturally at higher risk for cardiovascular complications. | ||
End stage renal disease requiring chronic dialysis following CIN occurs in a small proportion of patients<ref name="pmid12423705">{{cite journal| author=Freeman RV, O'Donnell M, Share D, Meengs WL, Kline-Rogers E, Clark VL et al.| title=Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. | journal=Am J Cardiol | year= 2002 | volume= 90 | issue= 10 | pages= 1068-73 | pmid=12423705 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12423705 }} </ref>, although data is still scarce. | End stage renal disease requiring chronic dialysis following CIN occurs in a small proportion of patients<ref name="pmid12423705">{{cite journal| author=Freeman RV, O'Donnell M, Share D, Meengs WL, Kline-Rogers E, Clark VL et al.| title=Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose. | journal=Am J Cardiol | year= 2002 | volume= 90 | issue= 10 | pages= 1068-73 | pmid=12423705 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12423705 }} </ref>, although data is still scarce. Usually patients that require chronic dialysis have some form of advanced kidney disease prior to exposure to contrast media. | ||
==References== | ==References== | ||
Revision as of 19:19, 2 October 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Moubarak, M.D. [2]
Overview
The reported incidence varies widely according to the presence or absence of risk factors, and usually associated with a significantly higher risk of in-hospital and 1-year mortality, even in patients who do not need dialysis.
Natural history, Complications and Prognosis
Studies have substantiated greater all-cause and cardiovascular mortality[1], prolonged duration of hospitalization[2], and late cardiovascular events[3] associated with CIN. The evidence is seen mostly in patients undergoing PCI.[4][5] Weisbord et al showed that an absolute increase in serum creatinine of 0.25 to 0.5 mg/dL within 72 hours after coronary angiography was associated with significantly greater odds for in-hospital mortality in the 30 day period following the procedure.[5] The need for dialysis following CIN is also a separate prognostic indicator. Dialysis requirement has been associated with a fivefold increase in all-cause mortality when compared to patients with CIN not requiring renal replacement. Furthermore, mortality in the former group was as high as 81% at 2 years.[6] Several of the studies targeting prognosis following CIN have been limited by the confounding factors mostly because high risk patients for CIN are naturally at higher risk for cardiovascular complications.
End stage renal disease requiring chronic dialysis following CIN occurs in a small proportion of patients[7], although data is still scarce. Usually patients that require chronic dialysis have some form of advanced kidney disease prior to exposure to contrast media.
References
- ↑ Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I; et al. (2004). "Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction". J Am Coll Cardiol. 44 (9): 1780–5. doi:10.1016/j.jacc.2004.07.043. PMID 15519007.
- ↑ McCullough PA, Sandberg KR (2003). "Epidemiology of contrast-induced nephropathy". Rev Cardiovasc Med. 4 Suppl 5: S3–9. PMID 14668704.
- ↑ McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F; et al. (2006). "Epidemiology and prognostic implications of contrast-induced nephropathy". Am J Cardiol. 98 (6A): 5K–13K. doi:10.1016/j.amjcard.2006.01.019. PMID 16949375.
- ↑ McCullough PA (2008). "Radiocontrast-induced acute kidney injury". Nephron Physiol. 109 (4): p61–72. doi:10.1159/000142938. PMID 18802377.
- ↑ 5.0 5.1 Weisbord SD, Chen H, Stone RA, Kip KE, Fine MJ, Saul MI; et al. (2006). "Associations of increases in serum creatinine with mortality and length of hospital stay after coronary angiography". J Am Soc Nephrol. 17 (10): 2871–7. doi:10.1681/ASN.2006030301. PMID 16928802.
- ↑ McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW (1997). "Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality". Am J Med. 103 (5): 368–75. PMID 9375704.
- ↑ Freeman RV, O'Donnell M, Share D, Meengs WL, Kline-Rogers E, Clark VL; et al. (2002). "Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose". Am J Cardiol. 90 (10): 1068–73. PMID 12423705.