| Background: Contrast-induced nephropathy (CIN) is a well-known complication of the therapeutic and diagnostic procedures which requires contrast administration. It is the third most common cause of hospital-acquired acute renal failure. The development of CIN is associated with increased length of hospital stay, an increased requirement for acute dialysis,and an increased risk of death.Serum creatinine is the most commonly used biochemical parameter to estimate CIN in routine practice. However, there are some shortcomings for the use of this parameter. Therefore, we should seek a more reliable indicator to estimate CIN in the early stage. Different from other causes of kidney disease, CIN can be prevented. Recognition of the high-risk patient coupled with appropriate periprocedural management can reduce the incidence of CIN in elderly patients. CIN often associated with a number of diseases. CIN may increase considerably. However, we do not pay sufficient attention to contrast agent nephrotoxicity problem.Objective: Prospective analysis a total of 172 elderly patients received PCI. To compare the change of renal function before and after radiographic contrast media and whether serum cystatin C is more sensitive and reliable than serum creatinine as a marker of CIN and the relation between radiocontrast and several risk factors.Methods: A total of 172 patients were enrolled in the study. We measured the serum cystatin C and serum creatinine levels at baseline and for the following five days, The data are expressed in mean±standard deviation. Correlations between quantitative data were determined using Pearson's test. P<0.05 was considered statistically significan. CIN was defined as a rise in Cre >0.5 mg/d. All patients use iohexol as radiographic contrast media. The diagnostic value of serum cystatin C and serum creatinine for identifying renal dysfunction was evaluated using receiver operating characteristic curve analysis, and the data are expressed as area under the curve (AUC; 95% confidence interval). Regression analysis risk factors of CIN, For statistical analysis, the SPSS12.0 program was used.Results: as to normal group (Cre <1.2 mg/dl), There are no statistically significant between Cre, Cys,and eGFR (p> 0.05), to mildly impaired (Cre 1.2-1.5 mg/dl), There are statistically significant between Cys,and eGFR (p <0.05), to seriously impaired (Cre >1.5 mg/dl), There are statistically significant between Cre, Cys, and eGFR (p<0.05), There was positive correlation between serum cystatin C and creatinine levels. Serum cystatin C was significant inversely correlated with eGFR (r=0.845 p<0.01). If CIN was defined as a rise in eGFR rise 25%, The receiver operating characteristic curve of serum cystatin C is 0.894 vs creatinine 0.717P<0.05, demonstrated that the diagnostic accuracy of the serum cystatin C level is superior to that of creatinine in identifying individuals with CIN, Of the 172 patients CIN occurred in 32 (19%), with baseline eGFR >60 ml/min, only 21 (13%) developed CIN, whereas it occurred in 19 (40%) of those with eGFR <60 ml/min (p < 0.0001) patients. Multivariate analysis demonstrated that the following variables remained to be significant factors correlating with CIN: baseline renal insufficiency,confidence interval, severe heart failure, contrast volume>300ml, age>75years, and contrast volume>300 ml. all of them P<0.001. patients with Diabetes mellitus occurred in12 (p=0.54), patients with hypertension occurred in 28 (p=0.16), The incidence of CIN in those patients who had renal dysfunction combining with Diabetes mellitus or hypertension previously was higher than those without renal dysfunction, p<0.01.Conclusion: Cystatin C is an accurate marker of subtle early changes in renal function and it may be superior to creatinine as an accurate marker of CIN. The most significant risk factors appear to be baseline renal insufficiency, baseline renal function, age>75, severe heart failure, contrast volume, multivariate arterial disease, are all independent predictor of CIN development after PCI. Patients with diabetes and pre-existing renal insufficiency have a greater risk of CIN.
|
PDF Full Text Request