Pre-procedural glucose levels and the risk for contrast-induced acute kidney injury in patients undergoing emergency coronary intervention

Hiroyuki Naruse, Junichi Ishii, Tousei Hashimoto, Tomoko Kawai, Kousuke Hattori, Masanori Okumura, Sadako Motoyama, Shigeru Matsui, Ikuko Tanaka, Hideo Izawa, Masanori Nomura, Yukio Ozaki

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Abstract

Background: The incidence, risk factors, and outcome of contrast-induced acute kidney injury (CI-AKI) in 730 patients with acute coronary syndrome (ACS) undergoing emergency percutaneous coronary intervention (PCI), whose contrast volume was below maximum allowable contrast dose (MACD) was prospectively investigated. Methods and Results: MACD was defined as (5 ml×body weight [kg]/baseline creatinine [mg/dl]). CI-AKI was defined as a greater than 25% increase in creatinine from the baseline or an absolute increase of ≥0.5 mg/dl within 48 h after the procedure. CI-AKI occurred in 212 (29%) patients. Patients with CI-AKI had a higher risk for in-hospital mortality (9.4% vs. 1.5%, P<0.001) and a longer stay in the coronary care unit (median, 4.0 vs. 3.0 days, P<0.001) compared with those without CI-AKI. In a multivariate logistic analysis including 20 clinical variables, elevated glucose levels as variables categorized into quartiles were independently (P<0.001) associated with the development of CI-AKI. In addition, this relationship was seen in both the subgroup of patients with known diabetes and that of those without known diabetes. Conclusions: CI-AKI might occur commonly and could be be associated with a more complicated clinical course in ACS patients undergoing emergency PCI whose contrast volume does not exceed MACD. Elevated pre-procedural glucose might be a powerful and independent risk factor for the development of CI-AKI in this population.

Original languageEnglish
Pages (from-to)1849-1855
Number of pages7
JournalCirculation Journal
Volume76
Issue number8
DOIs
Publication statusPublished - 02-08-2012

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Acute Kidney Injury
Emergencies
Glucose
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Creatinine
Coronary Care Units
Hospital Mortality
Multivariate Analysis
Weights and Measures
Incidence
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Naruse, Hiroyuki ; Ishii, Junichi ; Hashimoto, Tousei ; Kawai, Tomoko ; Hattori, Kousuke ; Okumura, Masanori ; Motoyama, Sadako ; Matsui, Shigeru ; Tanaka, Ikuko ; Izawa, Hideo ; Nomura, Masanori ; Ozaki, Yukio. / Pre-procedural glucose levels and the risk for contrast-induced acute kidney injury in patients undergoing emergency coronary intervention. In: Circulation Journal. 2012 ; Vol. 76, No. 8. pp. 1849-1855.
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Pre-procedural glucose levels and the risk for contrast-induced acute kidney injury in patients undergoing emergency coronary intervention. / Naruse, Hiroyuki; Ishii, Junichi; Hashimoto, Tousei; Kawai, Tomoko; Hattori, Kousuke; Okumura, Masanori; Motoyama, Sadako; Matsui, Shigeru; Tanaka, Ikuko; Izawa, Hideo; Nomura, Masanori; Ozaki, Yukio.

In: Circulation Journal, Vol. 76, No. 8, 02.08.2012, p. 1849-1855.

Research output: Contribution to journalArticle

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T1 - Pre-procedural glucose levels and the risk for contrast-induced acute kidney injury in patients undergoing emergency coronary intervention

AU - Naruse, Hiroyuki

AU - Ishii, Junichi

AU - Hashimoto, Tousei

AU - Kawai, Tomoko

AU - Hattori, Kousuke

AU - Okumura, Masanori

AU - Motoyama, Sadako

AU - Matsui, Shigeru

AU - Tanaka, Ikuko

AU - Izawa, Hideo

AU - Nomura, Masanori

AU - Ozaki, Yukio

PY - 2012/8/2

Y1 - 2012/8/2

N2 - Background: The incidence, risk factors, and outcome of contrast-induced acute kidney injury (CI-AKI) in 730 patients with acute coronary syndrome (ACS) undergoing emergency percutaneous coronary intervention (PCI), whose contrast volume was below maximum allowable contrast dose (MACD) was prospectively investigated. Methods and Results: MACD was defined as (5 ml×body weight [kg]/baseline creatinine [mg/dl]). CI-AKI was defined as a greater than 25% increase in creatinine from the baseline or an absolute increase of ≥0.5 mg/dl within 48 h after the procedure. CI-AKI occurred in 212 (29%) patients. Patients with CI-AKI had a higher risk for in-hospital mortality (9.4% vs. 1.5%, P<0.001) and a longer stay in the coronary care unit (median, 4.0 vs. 3.0 days, P<0.001) compared with those without CI-AKI. In a multivariate logistic analysis including 20 clinical variables, elevated glucose levels as variables categorized into quartiles were independently (P<0.001) associated with the development of CI-AKI. In addition, this relationship was seen in both the subgroup of patients with known diabetes and that of those without known diabetes. Conclusions: CI-AKI might occur commonly and could be be associated with a more complicated clinical course in ACS patients undergoing emergency PCI whose contrast volume does not exceed MACD. Elevated pre-procedural glucose might be a powerful and independent risk factor for the development of CI-AKI in this population.

AB - Background: The incidence, risk factors, and outcome of contrast-induced acute kidney injury (CI-AKI) in 730 patients with acute coronary syndrome (ACS) undergoing emergency percutaneous coronary intervention (PCI), whose contrast volume was below maximum allowable contrast dose (MACD) was prospectively investigated. Methods and Results: MACD was defined as (5 ml×body weight [kg]/baseline creatinine [mg/dl]). CI-AKI was defined as a greater than 25% increase in creatinine from the baseline or an absolute increase of ≥0.5 mg/dl within 48 h after the procedure. CI-AKI occurred in 212 (29%) patients. Patients with CI-AKI had a higher risk for in-hospital mortality (9.4% vs. 1.5%, P<0.001) and a longer stay in the coronary care unit (median, 4.0 vs. 3.0 days, P<0.001) compared with those without CI-AKI. In a multivariate logistic analysis including 20 clinical variables, elevated glucose levels as variables categorized into quartiles were independently (P<0.001) associated with the development of CI-AKI. In addition, this relationship was seen in both the subgroup of patients with known diabetes and that of those without known diabetes. Conclusions: CI-AKI might occur commonly and could be be associated with a more complicated clinical course in ACS patients undergoing emergency PCI whose contrast volume does not exceed MACD. Elevated pre-procedural glucose might be a powerful and independent risk factor for the development of CI-AKI in this population.

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