Clinical Characteristics And Prognosis Of Acute Kidney Injury Induced By Repeated Application Of Isotonic Or Hypotonic Contrast Media In A Short Period

Objective The purpose of this study was to evaluate the clinical characteristics of patients hospitalized with coronary artery disease(CAD),and to observe and analyze the long-term prognosis of patients with contrast-induced acute kidney injury(CI-AKI)induced by repeated application of isotonic or hypotonic contrast media within a short period of time.Methods This study analyzed retrospectively from January 2010 to January 2015 in the northern war zone during general hospital cardiovascular internal medicine underwent coronary angiography(CAG)or percutaneous coronary interention(PCI)of 23444 cases of coronary heart disease patients and screening with complete follow-up data within 30 days of repeated application of different osmotic pressure Contrast media(CM)of 504 cases of patients with coronary heart disease,According to the CM osmotic pressure,the patients in the two groups were divided into the isotonic group(n=299)and the hypotonic group(n=205),and each group was of the same type of CM.The clinical occurrence characteristics of CI-AKI after two postoperative operations as well as the occurrence of all-cause death and major advanced cardiovascular events(MACE)events during the long-term follow-up were recorded and analyzed.Results 1.Baseline analysis: smoking rate was lower in the isotonic contrast group [126(42.1%)vs.126(61.5%),P<0.001],showing statistical difference.Baseline Scr was higher(82.52±27.56 vs.73.08±20.61,P<0.001)and baseline eGFR was lower(88.73±34.88 vs.100.87±31.28,P<0.001)in the isotonic contrast group.In the isotonic contrast group,the admission systolic blood pressure was higher(135.34±22.55 vs.131.06±24.89,P=0.045),and the admission diastolic blood pressure was higher(80.20±13.62 vs.77.41±14.55,P=0.028).2.Preoperative drug and laboratory results: The proportion of previous statins used in the isotonic contrast group was lower [159(53.2%)vs.144(70.2%),P<0.001],the prothrombin time was lower(12.95±1.62 vs.13.29±1.51,P=0.048),and the LDL was lower(2.39±0.91 vs.2.63±1.00,P= 0.018),lower total cholesterol(4.14±1.09 vs.4.44±1.35,P = 0.019),lower preoperative white blood cells(7.99 ±2.78 vs.8.81±3.40,P = 0.013).The proportion of CCB drug use in the isotonic contrast group was higher [141(47.2%)vs.78(38.0%),P=0.043],the proportion of ACEI/ARB was higher [249(83.3%)vs.153(74.6%),P=0.018],and the peak value of troponin-T was higher [1.3(0.15,4.79)vs.0.69(0.05,2.75),P=0.007],all of which showed statistical differences.3.Surgical status: the comparison between the isotonic group and the hypotonic group with the occurrence of CI-AKI after the first operation: [30(10.0%)vs.14(6.8%%),P=0.211],no statistical difference was found.The occurrence of CI-AKI after the second operation was compared between the isotonic group and the hypotonic group: [17(5.7%)vs.22(10.7%),P= 0.037],showing a statistical difference.The number of stents used in the isotonic contrast group was less(1.91±1.22 vs.2.42±1.76,P=0.001),and the length of stents was shorter(60.71±36.57 vs.72.16±45.29,P=0.004).eGFR was lower in the isotonic group after the first operation(82.92±35.65 vs.96.36±35.15,P=0.001).eGFR was lower in the isotonic group before the second operation(89.19±37.15 vs.101.06±34.27,P<0.001).eGFR was lower in the isotonic group after the second operation(91.12±39.41 vs.102.30±38.36,P=0.003).The baseline serum creatinine value(Scr)of the isotonic contrast group was higher(82.52±27.56 vs 73.08±20.61,P<0.001),higher serum creatinine value after the first operation(90.65±40.43 vs 79.36±26.89,P=0.008),higher serum creatinine value before the second operation(83.22±33.09 vs 73.75±21.95,P<0.001),higher serum creatinine value after the second operation(82.46±30.45 vs 74.98±26.22,P=0.007),in which the eGFR of the first perioperative isotonic group was more than 60 ml/min/1.73m~2 [60(20.7%)vs.14(6.8%),P<0.001],and that of the second preoperative isotonic group was more than 60 ml/min/1.73m~2 [63(21.1%)vs.19(9.3%),P<0.001].After the second operation,the eGFR in the isotonic group was more than 60 ml/min/1.73m~2 [61(20.4%)vs.21(10.2%),P=0.002],all of which showed statistical differences.4.The dose of contrast media in the second operation was more in the isotonic group than in the first operation(137.20±92.20 vs.161.65±85.88,P=0.014);the dose of contrast agent in the second operation was more in the hypotonic group than in the first operation(122.84±84.43 vs.157.53±85.05,P<0.001);the Scr after the first operation was more in the isotonic group than before the first operation(85.85±29.14 vs.90.65±40.43,P=0.002).Moreover,the Scr after the second operation in the isotonic group was lower than that after the first operation(90.57±41.61 vs.86.95±32.34,P=0.021),indicating that Scr recovered significantly and was statistically significant.The number of cases of CI-AKI after the second operation in the isotonic group decreased from that of the first [30(10.0%)vs.17(5.7%),P=0.045],which was statistically significant.5.Logistic multivariate regression analysis showed that diuretics(OR=9.688,95%CI: 2.422-38.741,P=0.001),diabetes history(OR=3.319,95%CI: 1.090-10.102,P=0.035)and dose of contrast media(OR=0.991,95%CI:0.983-0.999,P=0.025)were independent risk factors for the first occurrence of CI-AKI in the isotonic group.The history of hypertension(OR=5.828,95%CI :1.170-29.024,P=0.031)was an independent risk factor for the second postoperative CI-AKI in the isotonic group.The use of ACEI/ARB(OR=3.397,95%CI: 1.077-10.713,P=0.037)was an independent risk factor for the second postoperative CI-AKI in the hypotonic group.6.End-point events during follow-up: there was no statistically significant difference between the two groups in the incidence of all-cause death(P=0.875)and overall MACE(P=0.923)during follow-up.There were no statistically significant differences in the rates of cardiogenic death,stent thrombosis,recurrent myocardial infarction and stent restenosis between the two groups(P>0.05).Conclusions The incidence of CI-AKI induced by the second exposure to isotonic contrast media in a short period of time(30 days)was lower than that caused by the second exposure to isotonic contrast agent.Diuretics,diabetes and the amount of contrast media are independent related risk factors for the occurrence of CI-AKI after the first exposure to isotonic contrast media.Therefore,when the first exposure to isotonic contrast media,diuretics should be used cautiously and contrast media should be used sparsely.Hypertension is an independent risk factor for the second occurrence of CI-AKI in the isotonic group,so it is necessary to actively prevent and control blood pressure.The use of ACEI/ARB was an independent risk factor for the second occurrence of CI-AKI in the hypotonic group.