Risk Factors And Severity Of Illness Of Contrast-induced Nephropathy In Elderly Patients With Diabetes

OBJECTIVE To understand the clinic feature of the elderly patients with diabetes during coronary angiography, analyze risk factors and severity of illness of contrast-induced nephropathy (CIN) in the patients.METHODS We studied and analyzed retrospectively the risk factors and severity of illness of CIN. The study involved 269 elderly patients who had coronary angiography and percutaneous coronary intervention (PCI) from January 2007 to December 2009 in our hospital. The patients were divided into two groups according to the presence of CIN. The possible risk factors for CIN, such as glycemic control, diabetic complication, renal function, volume of contrast medium, inflammatory state, therapy of perioperative period, past medical history, were analyzed and compared between the two groups. Moreover, we divided the patients with CIN into two groups in the light of severity of illness in order to determine the possible factors aggravating CIN.RESULTS In 269 elderly patients with diabetes, the incidence of CIN was 9.3% (25/269). According to estimated glomerular filtration rate (e-GFR),we separate the patients into four subgroup:≥90ml/min,90-60ml/min,60-30ml/min,<30ml/min; then we found the incidence of CIN for subgroup is 2.2%(1/45),4.4%(6/135),17.3% (14/81),50%(4/8) respectively. In the patients, the prevalence of hypertension was 80.7%, the prevalence of chronic kidney disease (CKD) was 29.7%, the prevalence of myocardial infarction was 24.2%, the incidence of diabetic nephropathy and retinopathy was 25.7% and 21.9%, separately.The mean of preoperative e-GFR was 70.14±21.55ml/min, the mean volume of contrast medium (iohexol) was 176.83±71.75ml. Weight, incidence of CKD, diabetic complication, preoperative e-GFR, RBC, albumin, inflammatory state, urine PH, volume of contrast medium, multiple coronary artery disease, intravenous hydration prevention, coronary angiography complication, creatinine concentration, angiotensin-converting enzyme inhibitor (ACEI)(?) and loop diuretic use, hospital day in CIN group were significantly higher than those in the control group (P<0.01 or 0.05). Multivariate logistic gradual regressive analysis showed that loop diuretic use, preoperative e-GFR (<60ml/min), volume of contrast medium (≥200ml), CKD were independent risk factors of CIN.Their odds ratio (OR) was 6.07,3.27,3.26,2.80, respectively, P value was 0.001,0.024,0.015, 0.048, respectively.In analysis for severity of CIN, CKD, preoperative e-GFR, diabetic nephropathy and retinopathy, left ventricular ejection fraction (LVEF) between two groups were significantly different (P<0.05)CONCLUSION Loop diuretic use, preoperative GFR (<60ml/min), volume of contrast medium (≥200ml), CKD are independent risk factors of CIN. CKD, preoperative GFR (<45ml/min), diabetic nephropathy and retinopathy have an effect on the severity of CIN.