Investigation Of Kidney Disease In 452 Cases Undergoing Coronary Angiography

Objective:Microalbuminuria,Cystatin C(CysC)and estimated glomerular filtration rate(e GFR)were used to investigate the prevalence of kidney disease in patients undergoing coronary angiography,and to prospectively evaluate the importance of CysC in the diagnosis of contrast-induced acute kidney injury(CI-AKI)after coronary angiography.Methods: Our samples were patients who underwent coronary angiography in Cardiology Department in in the Second Affiliated Hospital of Dalian Medical University from January 2015 to December 2015.Exclusion criteria were: 1.Acute or chronic infectious diseases;2.other organic heart disease;3.other causes of acute kidney injury;4.solitary kidney,unilateral renal atrophy or renal artery stenosis;5.active autoimmune diseases;6.cardiac shock or septic shock;7.coronary artery bypass grafting or an important organ transplantation such as heart and kidney;8.Patients with malignancy;9 repeated hospitalization,incomplete data,dead patients.Patients’ age,gender,blood pressure and heart rate were recorded.Medical and drug history were asked in detail,and indexes of high sensitive C reactive protein(Hs-CRP),serum uric acid,Urea and other laboratory investigations were collected.Left ventricular mass index(LVMI)was calculated according to the results of echocardiography in patients.Serum creatinine(Scr),CysC,urinary albumin creatinine ratio(UACR),24 hours before and 48 hours after coronary angiography,were determined.To calculate the e GFR,we used the MDRD formula,CKD-EPI formula(2009)-based on the Scr and the CKD-EPI formula(2012)-based on CysC and Scr.According to the level of proteinuria and e GFR,the patients were divided into renal disease group and non renal disease group.The prevalence and risk factors of renal disease in patients with coronary angiography were analyzed.The results all of coronary angiography and dose of contrast medium used were recorded.The Mehran’s CI-AKI risk scoring model was used to assess the risk for all patients undergoing coronary angiography.Increased Scr levels-an increase in Scr of ≥ 44.5 μmol/L or an increase in 25% from the baseline value,was used to determine whether the patients had CI-AKI along with the application of ROC curve analysis of cystatin C to diagnose CI-AKI.Results: 1.452 patients underwent coronary angiography and the average age was64.22±9.94 years.275 patients were considered as coronary heart disease(CHD)by coronary angiography(60.8%),(93 cases)33.8% of which have coronary artery lesions in one branch only;30.2%(83 cases)of which has 2 lesions involved,99 cases(36.0%)have lessions in all the three main coronary vessels.119(26.3%)patients were confirmed cases of kidney disease by urine test and serological examination,out of which 83 cases(69.7%)had coronary heart disease.2.Patients with CHD were younger than those in non CHD group(P < 0.05),while the level of CysC and UACR was higher than that in patients with non CHD group(P < 0.05).3.In patients with different coronary lessions,the level of UACR,CysC and e GFR levels were unalike(P < 0.05).When comparing between the 0-1 coronary artery lesions patients group,the levels of CysC and UACR were lower than the 2-3lesions(P < 0.05),while the level of e GFR was higher than the latter(P < 0.05).4.Patients with kidney disease were older than that in the patients with non renal disease group(P < 0.001).The prevalence of diabetes,hypertension,coronary heart disease and left ventricular hypertrophy in the kidney disease group were higher than those in the non renal disease group(P < 0.01).Compared with the non renal patients,the pulse pressure,HS-CRP,SCr,CysC,UA,UACR,LVMI levels were higher in the patients with kidney disease(P < 0.05).5.CHD patients complicated with kidney disease are older(P < 0.001),have a higher prevalence of diabetes and hypertension(P < 0.05)and a higher systolic blood pressure and pulse pressure(P < 0.05)than those CHD patients without kidney disease.HS-CRP,Scr,UA,CysC,UACR in patients with coronary heart disease complicated with kidney disease were higher than those in the non concurrent renal disease group(P< 0.01).6.Multivariate logistic regression analysis showed that increasing age(OR=1.062,95%CI 1.023-1.103),hyperuricemia(OR=1.005,95%CI 1.001-1.008),high CysC(OR=2.985,95%CI 1.162-7.672),diabetes mellitus(OR=2.328,95%CI1.251-4.331)and increasing Hs-CRP(OR=1.030,95%CI 1.005-1.056)were the risk factors for kidney disease.7.Increased Scr level was used for the diagnosis of CI-AKI.6 patients(5.4%)developed CI-AKI according to the Scr criteria after coronary angiography.CI-AKI patients with CysC,Scr,Urea were significantly higher than the non CI-AKI group(P <0.05),and the level of e GFR were lower than the non CI-AKI group(P < 0.05).The area under the ROC curve(AUC)of CysC is 0.874(0.759~0.989 95%CI,P=0.002).After coronary angiography if CysC greater than or equal to 1.235mg/L,the sensitivity was100%,the specificity was 62.3%,the Youden index was 0.623.Conclusions: 1 patient with coronary heart disease have high incidence of kidney disease but low awareness rate;2 patients with coronary heart disease have lower levels of UACR,e GFR and higher level of CysC than non coronary heart disease patients;3 As the number of coronary artery lesions increase,the patients have decrease in e GFR and increase in CysC and UACR;4 Age,hyperuricemia,diabetes mellitus,high level of Hs-CRP and CysC were the main risk factors for the occurrence of kidney disease in patients with coronary heart disease;5 CysC has high sensitivity and specificity in prediction of CI-AKI and can be used for the diagnosis of CI-AKI.