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Pre-procedural renal resistive index accurately predicts contrast-induced acute kidney injury in patients with preserved renal function submitted to coronary angiography #MMPMID27995343
Wybraniec MT; Bo?entowicz-Wikarek M; Chudek J; Mizia-Stec K
Int J Cardiovasc Imaging 2017[]; 33 (5): 595-604 PMID27995343show ga
The study aimed to evaluate the clinical utility of ultrasonographic intra-renal blood flow parameters, together with the wide range of different risk factors, for the prediction of contrast-induced acute kidney injury (CI-AKI) in patients with preserved renal function, referred for coronary angiography or percutaneous coronary interventions (CA/PCI). This prospective study covered 95 consecutive patients (69.5% men; median age 65 years) subject to elective or urgent CA/PCI. Data regarding 128 peri-procedural variables were collected. Ultrasonographic intra-renal blood flow parameters, including renal resistive index (RRI) and pulsatility index (RPI), were acquired directly before the procedure. CI-AKI was defined as ?50% relative or ?0.3 mg/dL absolute increase of serum creatinine 48 h after procedure. CI-AKI was confirmed in nine patients (9.5%). Patients with CI-AKI had higher SYNTAX score (p?=?0.0002), higher rate of left main disease (p?0.00001), peripheral artery disease (PAD; p?=?0.02), coronary artery anomaly (p?=?0.017), more frequently underwent surgical revascularization (p?=?0.0003), ?had greater...? intima-(p?=?0.004) and extra-medial thickness (p?=?0.001), and received higher contrast media dose (p?=?0.049), more often overused non-steroidal anti-inflammatory drugs (p?=?0.001), and had substantially higher pre-procedural RRI (0.69 vs. 0.62; p?=?0.005) and RPI values (1.54 vs. 1.36; p?=?0.017). Logistic regression confirmed age, SYNTAX score, presence of PAD, diabetes mellitus, and pre-procedural RRI independently predicted CI-AKI onset (AUC?=?0.95; p?0.0001). Pre-procedural RRI?>?0.69 had 78% sensitivity and 81% specificity in CI-AKI prediction. High pre-procedural RRI seems to be a useful novel risk factor for CI-AKI in patients with preserved renal function. Coronary, peripheral and renal vascular pathology contribute to the development of CI-AKI following CA/PCI.