Evaluation of Risk Factors for Contrast Medium-Associated Acute Nephrotoxicity after Cardiac Catheterization: A Case-Control Study

• Main Authors: Chi-Cheng Ho, 何啟正
• Other Authors: Chiau-Suong Liau
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/77338052148654309220

碩士 === 國立臺灣大學 === 臨床藥學研究所 === 92 === Background: Contrast medium-associated acute nephrotoxicity (CAN) is one of the most important complications of cardiac catheterization, and the incidence of CAN rises as the number of risk factors. Although renal function of patients with CAN usually recovers in a few days, CAN may lead to prolongation of hospital stay, increased medical expenditures, or even emergent dialysis in high-risk patients. According to the literature, important risk factors for CAN are preexisting renal dysfunction, diabetic mellitus and a larger volume of contrast medium administration, congestive heart failure, etc. However, the definition and cutoff point of these risk factors vary with different studies, and the effect of other factors contributable to CAN, like vaso-acting agents or other nephrotoxic drugs, remains unknown. Besides, there is no pharmaco-epidemiological data of CAN in Taiwan Chinese population, leaving the presentation of CAN and differences in risk factors between populations undetected. Method: A retrospective case-control study was conducted in NTUH between June 2002 and May 2003. Patients undergoing cardiac catheterization were included if they had serum creatinine monitored within 2 days pre-procedure and 2 to 5 days post-procedure. Cases were selected if the criteria of CAN (Defined as a more than 0.5mg/dL or 25% increase in serum creatinine) were met, while controls were randomly selected in a 1:1 manner with cases from those who didn’t meet the criteria of CAN. Exclusion criteria were established acute renal failure pre-procedure, regular dialysis or intermittent dialysis within 1 week pre-procedure. Demographic data, underlying disease, data of cardiac catheterization, lab tests, vital signs, important clinical events (ex: shock of any cause, any post-procedure surgery, etc.), concurrent medications and renal function-related variables were all recorded. Logistic regression was utilized to find out important risk factors and independent predictors of CAN after cardiac catheterization. Result: There were 2691 consecutive procedures of cardiac catheterization during study period, and 154 patients were selected according to inclusion/exclusion criteria, including 77 cases and 77 controls. Peak concentration of serum creatinine was achieved 2 to 3 days after the procedure among cases. 25% of cases developed oligouria or unuria after the procedure, and 23.4% of cases received dialysis. Multivariate logistic regression showed that female gender, congestive heart failure, diabetic mellitus, repeated contrast medium injection, post-procedure surgery, new or increased dose of diuretics, new or increased dose of inotropic agents and dose of contrast medium were independent predictors of CAN. Baseline serum creatinine and creatinine clearance were also statistically significant variables in simple logistic regression analysis. Conclusion: In addition to other proved risk factors according to literature like chronic renal insufficiency, diabetic mellitus and dose of contrast medium, we found that diuretics and some vaso-acting drugs like inotropic agents may also play a role in CAN. The results may provide clinicians more information of CAN to improve the safety of cardiac catheterization.