Study On The Incidence Of Acute Kidney Injury In Patients With Mild To Moderate Renal Insufficiency Of Post-PCI

Background:contrast media CM,is one of the most commonly used drugs in interventional radiology.It is mainly used for the display of blood vessels,body cavities or tissues.It can generally be safely excreted through the kidney,but in some cases it may impair kidney function and lead to post-contrast acute kidney injury(PCAKI).It is a common complication in percutaneous coronary intervention(PCI),which affects the outcome and prognosis of patients.Clinically,many ACS patients are complicated with different degrees of renal insufficiency.What is the difference of contrast nephropathy after coronary intervention in patients with different renal function? What degree of caution should be taken in the use of contrast media in some patients with mild-moderate renal insufficiency? Relevant clinical studies are needed to verify.This will affect the medical decisions of patients with ACS.Objective:To explore the risk factors of contrast nephropathy after coronary intervention in patients with acute coronary syndrome.To explore different degrees of renal insufficiency [patients were divided into:(1)normal renal function: e GFR≥90 ml/(min.1.73m2);(2)mild renal insufficiency: 60≤e GFR < 90 ml/(min.1.73m2);(3)moderate renal insufficiency:(4)Severe renal insufficiency: e GFR < 30ml/(min.1.73m2)】 in patients with ACS after coronary interventional therapy: incidence of contrast nephropathy.Methods:This study is retrospective and observational.Patients with acute coronary syndrome admitted to the coronary heart disease ward of Huazhong Fuwai Hospital from January 1,2020 to January 31,2021 were selected.According to the inclusion and exclusion criteria,the included cases were studied.The electronic medical record management system was used to collect detailed clinical medical record data,various auxiliary examinations and laboratory test data.SPSS statistical software was used to compare the general characteristics and baseline conditions of ACS patients with different renal functions within 24 hours before surgery,as well as the incidence of contrast nephropathy after coronary intervention,and to further analyze the independent influencing factors of contrast nephropathy by multivariate Logistic regression.P<0.05 meant the difference was statistically significant.Results:1.Comparison of data between patients with and without PC-AKI: Univariate analysis showed that there was no significant difference between the PC-AKI group and the non-PC-Aki group in age,sex,BMI,diabetes,hyperlipidemia,myocardial infarction,anemia,Hb value,total protein,albumin,contrast agent dosage,baseline creatinine level,Hb A1 c and other aspects(P > 0.05).There were statistically significant differences in hypertension,heart failure,EF,baseline e GFR and urea values between the two groups(P <0.05).2.Comparison of data between patients with mild to moderate renal insufficiency and patients with normal renal function:2.1 In the normal renal function group,the mildly decreased renal function group and the moderately decreased renal function group,there was no difference in gender,BMI and the incidence of PC-AKI,but with the decline of renal function,the incidence of PC-AKI showed an increasing trend.2.2 Differences in the incidence of hypertension: The incidence of hypertension in the moderately decreased renal function group was higher than that in the normal renal function group(82.8%vs56.9%),X2= 7.099 p =0.008;The incidence of hypertension in the mildly decreased renal function group was higher than that in the normal renal function group(70.5%vs56.9%),X2=6.341 p=0.012;There was no difference in the incidence of hypertension between the moderately decreased renal function group and the mildly decreased renal function group.2.3 Differences in the incidence of diabetes: The incidence of diabetes in the moderately decreased renal function group was higher than that in the normal renal function group(72.4%vs40.7%),X2=10.386 p=0.001;The incidence of diabetes mellitus in the moderately decreased renal function group was higher than that in the mildly decreased renal function group(72.4%vs39.5%),X2=10.319 p=0.001;There was no difference in the incidence of diabetes between the moderately decreased renal function group and the mildly decreased renal function group.2.4 Differences in the incidence of hyperlipidemia: The incidence of hyperlipidemia in the moderately decreased renal function group was higher than that in the mildly decreased renal function group(86.2%vs60.5%),X2=6.914 p=0.009;There was no difference between the other groups.2.5 Difference in the incidence of heart failure: The rate of heart failure was higher in the moderately decreased renal function group than in the normal renal function group(62.1%vs34.7%),X2= 8.119 p =0.004.There was no difference between the other groups.2.6 Differences in the incidence of myocardial infarction: The incidence of myocardial infarction was higher in the moderately decreased renal function group than in the normal renal function group(55.2%vs25.9%),X2=10.539 p=0.001.2.7 Differences in the incidence of anemia: The incidence of anemia in the moderately decreased renal function group was higher than that in the mildly decreased renal function group(65.5%vs24.8%),X2=17.952 p < 0.001;The incidence of anemia was higher in the moderately decreased renal function group than in the normal renal function group(65.5%vs25.5%),X2=19.458 p < 0.001.3.In combination with adequate hydration,the creatinine value of patients with normal renal function increased after surgery,and there was statistical significance(P < 0.05),while there was no statistical significance in creatinine value of patients with mild and moderate renal insufficiency before and after surgery.4.Logistic regression analysis showed that the effects of EF and SCr level before surgery were statistically significant,and they were independent risk factors for postoperative PC-AKI(P < 0.05).5.The incidence of PC-AKI is affected by the diagnostic criteria.The incidence of patients with normal renal function using the old diagnostic criteria is more than that of the new diagnostic criteria,while there is no difference in the incidence of patients with mild and moderate renal insufficiency using the new and old diagnostic criteria.Conclusions:1,the occurrence of PC-AKI is related to a variety of factors;EF and preoperative SCr levels were independent risk factors for postoperative PC-AKI.2.There was no difference in the incidence of PC-AKI among patients with different renal function.3.Different criteria will affect the diagnosis of PC-AKI.The old diagnostic criteria for the incidence of PC-AKI in people with normal renal function are higher than the new criteria,and the new diagnostic criteria are more stringent for the diagnosis of PC-AKI.