What factors are Associated with the Development of Contras-induced Nephropathy in Elderly Patients with Acute Coronary Syndrome in Real Clinical Practice?

Aim. To study the factors associated with contrast-induced acute kidney injury in elderly patients with acute coronary syndrome (ACS).
Material and Methods. A retrospective analysis of 514 electronic medical records of patients aged 75 years and over (38% men and 62% women) with confirmed acute coronary syndrome has been performed. The contrast-induced acute kidney injury was defined as an increase in serum creatinine ≥26.5 μmol/L in 48 h or as an increase in serum creatinine in 1.5 times within 7 days after the contrast media exposure. Patients were divided into contrast-induced acute kidney injury and non-contrast-induced acute kidney injury group. Clinical characteristics and in-hospital outcomes were extracted from patients' medical records. Procedural characteristics were obtained from laboratory database.
Results. Angiographic intervention was performed in 74% of patients, 32% of them (more often in women, p=0.033) were diagnosed with contrast-induced acute kidney injury. Patients with contrast-induced acute kidney injury are characterized by a higher death rate (17% и 3%, p<0.001) and were more likely to have heart failure with reduced ejection fraction (34% и 21%, p=0.008) and acute heart failure (Killip class II-IV) (24% и 16%, p=0.015). The risk of developing contrast-induced acute kidney injury was related the volume of contrast medium administered.
Conclusions. Prevention particular care should be taken to female patients older than 75 years with ACS, with a history of the chronic heart failure with reduced ejection fraction or acute heart failure (Killip class II-IV), and with a high volume of contrast media, highlighting that a perioperative comprehensive management strategy is needed to improve the prognosis.

1. Morzycki A., Bhatia A., Murphy K.J. Adverse Reactions to Contrast Material: A Canadian Update. Can Assoc Radiol J. 2017;68(2):187-93. DOI:10.1016/j.carj.2016.05.006.

2. Laville M., Juillard L. Contrast-induced acute kidney injury: how should at-risk patients be identified and managed? J Nephrol. 2010;23(4):387-98.

3. Dicker D., Nguyen G., Abate D. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159): 684-735. DOI:10.1016/S0140-6736(18)31891-9.

4. Fliser D., Laville M., Covic A., et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant. 2012;27(12):4263-72. DOI:10.1093/ndt/gfs375.

5. Morcos S.K., Thomsen H.S.,Webb J.A. Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol. 1999;9(8):1602-136. DOI:10.1007/s003300050894.

6. Erlich A.D., Gratsiansky N.A. and participants of the RECORD registry. Registry RECORD. Treatmentof patients with acute coronary syndromes in hospitals with and without the possibility of performingin-vasive coronary procedures. Kardiologiia. 2010;7:8-14 (In Russ.)

7. Erlich A.D., Gratsiansky N.A. On behalf of participants in the RECORD registry. Registry of acute coronarysyndromes RECORD. Characteristics of patients and treatment before discharge from hospital. Kardiologiia. 2009;7:4-12 (In Russ.)

8. Gilyarov M.Y, Zheltoukhova M.O., Konstantinova E.V., et al. Treatment characteristics of acute coronarysyndrome in elderly patients: practice of N.I. Pirogov city clinical hospital №1. Rational Pharmacotherapy in Cardiology. 2017;13(2):164-70 (In Russ.). DOI:10.20996/1819-6446-2017-13-2-164-170.

9. Yuan Y., Qiu H., Hu X.Y., et al., Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention. Chin Med J (Engl). 2017;130(1): 45-50. DOI:10.4103/0366-6999.196578.

10. Pan H.C., Wu X.H., Wan Q.L., et al. Analysis of the risk factors for contrast-induced nephropathy in over-aged patients receiving coronary intervention. Exp Biol Med (Maywood). 2018;243(12):970-5. DOI:10.1177/1535370218799973.

11. Azzalini L., Poletti E, Lombardo F., et al. Risk of contrast-induced nephropathy in patients undergoing complex percutaneous coronary intervention. Int J Cardiol. 2019;290:59-63. DOI:10.1016/j.ijcard.2019.04.043.

12. McCullough P.A., Choi J.P., Feghali G.A. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51:1419-28. DOI:10.1016/j.jacc.2007.12.035.

13. Rudnick M.R., Goldfarb S., Wexler L., et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study. Kidney Int. 1995;47(1):254-61. DOI:10.1038/ki.1995.32.

14. Sinkovic A., Masnik K., Mihevc M. Predictors of acute kidney injury (AKI) in high-risk ST-elevation myocardial infarction (STEMI) patients: A single-center retrospective observational study. Bosn J Basic Med Sci. 2019;19(1):101-8. DOI:10.17305/bjbms.2018.3797.

15. Grossman P.M., Syed S.A., Aronow H.D., et al. Contrast-induced nephropathy in patients undergoing endovascular peripheral vascular intervention: Incidence, risk factors, and outcomes as observed in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. J Interv Cardiol. 2017;30(3):274-80. DOI:10.1111/joic.12379.

16. Abe M., Morimoto Т., Akao M., et al. Relation of contrast-induced nephropathy to long-term mortality after percutaneous coronary intervention. Am J Cardiol. 2014;114(3):362-8. DOI:10.1016/j.amjcard.2014.05.009.

17. Aubry P., Brillet G., Gatella L., et al. Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures. BMC Nephrol. 2016;17(1):167. DOI:10.1186/s12882-016-0385-5

18. Mehran R., Dangas G.D.,Weisbord S.D. Contrast-Associated Acute Kidney Injury. N Engl J Med. 2019;380(22):2146-55. DOI:10.1056/NEJMra1805256.

19. Kawatani Y, Kurobe H., Nakamura Y, et al. The ratio of contrast medium volume to estimated glomerular filtration rate as a predictor of contrast-induced nephropathy after endovascular aortic repair. J Med Invest. 2018. 65(1.2): 116-121. DOI:10.2152/jmi.65.116

20. Maioli M., Toso A., Gallopin M., et al. Preprocedural score for risk of contrast-induced nephropathy in elective coronary angiography and intervention. J Cardiovasc Med (Hagerstown). 2010;11(6):444-9. DOI:10.2459/JCM.0b013e328335227c.

21. Dong M., Jiao Z., Liu T., et al. Effect of administration route on the renal safety of contrast agents: a meta-analysis of randomized controlled trials. J Nephrol. 2012;25(3):290-301. DOI:10.5301/jn.5000067.

22. Pyxaras S.A., Sinagra G., Mangiacapra F., et al. Contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention without acute left ventricular ejection fraction impairment. Am J Cardiol. 2013;111:684-8. DOI:10.1016/j.amjcard.2012.11.018.

23. Watabe H., Sato A., Hoshi T., et al. Association of contrast-induced acute kidney injury with longterm cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention. Int J Cardiol. 2014;174:57-63. DOI:10.1016/j.ij-card.2014.03.146.