Early Small Creatinine Shift Predicts Contrast-Induced Acute Kidney Injury and Persistent Renal Damage after Percutaneous Coronary Procedures

Purpose: Little is known on the impact of contrast-induced acute kidney injury (CI-AKI) on mid- and long-term renal function after percutaneous coronary procedure. The aim of the study was to investigate the incidence of persistent renal damage (PRD) after CI-AKI in a cohort of patients undergoing coronary angiography and/or intervention. Moreover, we sought to assess the predictive value of small creatinine change at 12-24 h (SCr Delta% 12-24 h) from contrast exposure in predicting CI-AKI and PRD. Methods: Complete clinical and biochemical data of 731 patients were retrospectively analyzed at sequential time intervals at baseline, 12-24 h and 48-72 h from the procedure. Data at 30 +/- 10 days and 12-24 months were available in 59% and 49% of the cases respectively. Logistic regression was used to assess variables associated with CI-AKI and PRD. ROC analysis was used to test the diagnostic accuracy of SCr Delta%12-24 h in predicting CI-AKI and PRD. Results: CI-AKI occurred in 130/731 patients (17.8%). At 30 +/- 10 days PRD occurred in 54.8% patients who developed CI-AKI. A SCr Delta%12-24 h >5% demonstrated independent predictive value (OR= 1.05, CI = 1.04-1.06, p < 0.001) and fair accuracy (AUC= 0.80, CI = 0.77-0.84) for CI-AKI. Conclusion: CI-AKI was associated with PRD in >50% of the cases in this single centre cohort. A small and early SCr Delta%12-24 h demonstrated high predictive value for CI-AKI and may be used as a useful tool to unmask a group of patients at risk for PRD after percutaneous coronary procedures. (c) 2019 Elsevier Inc. All rights reserved.