Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose

被引:269
作者
Freeman, RV
O'Donnell, M
Share, D
Meengs, WL
Kline-Rogers, E
Clark, VL
DeFranco, AC
Eagle, KA
McGinnity, JG
Patel, K
Maxwell-Eward, A
Bondie, D
Moscucci, M
机构
[1] Univ Michigan, Med Ctr, Taubman Ctr B1 226, Div Cardiol,Blue Cross Blue Shield Michigan Cardi, Ann Arbor, MI 48109 USA
[2] Univ Washington, Div Cardiol, Seattle, WA 98195 USA
[3] St Joseph Mercy Hosp, Ann Arbor, MI 48104 USA
[4] Bluecross Blue Shield Ctr Hlth Care Qual, Detroit, MI USA
[5] Henry Ford Hosp, Detroit, MI 48202 USA
[6] Harper Grace Hosp, Detroit, MI 48201 USA
[7] Spectrum Hlth, Grand Rapids, MI USA
[8] No Michigan Hosp, Petroskey, MI USA
[9] McLaren Reg Med Ctr, Flint, MI USA
[10] Hop St Joseph, Pontiac, MI USA
关键词
D O I
10.1016/S0002-9149(02)02771-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
This study was undertaken to determine the incidence, risk factors, and in-hospital outcome of nephropathy requiring dialysis (NRD) after percutaneous coronary intervention (PCI), and to evaluate the role of a weight- and creatinine-adjusted maximum radiographic contrast close (MRCD) on NRD. Data were obtained from a registry of 16,592 PCIs. The data were divided into development and test sets. Univariate predictors were identified and a multivariate logistic regression model was developed. The MRCD was calculated for each patient as: MRCD = 5 ml x body weight -(kilograms)/ serum creatinine (milligrams per deciliter). Predictive accuracy was assessed by receiver-operating characteristic curve analysis.. In the development set, 41 patients (0.44%) developed NRD with a subsequent in-hospital mortality. rate of 39.0%. NRD increased with worsening baseline renal dysfunction. Other risk factors included peripheral vascular disease, diabetes mellitus, congestive heart failure, and cardiogenic shock. There was a direct relation between the number of risk factors and NRD. After adjustment for baseline risk factors, MRCD was the strongest independent predictor of NRD (adjusted odds ratio 6.2, 95% confidence interval 3.0 to 12.8). NRD and in-hospital mortality were both significantly higher in patients who exceeded the MRCD compared with patients who did not (p <0.001). In conclusion, NRD following PCI is a rare complication with a poor prognosis. Baseline clinical characteristics identify patients at greatest risk for NRD. Optimization of procedural variables such-as timing of the intervention relative to the diagnostic catheterization, staging coronary procedures, or dosing within the MRCD may help reduce the risk of this complication in high-risk patients. A risk prediction tool for NRD with guidelines for prevention is presented. (C) 2002 by Excerpta Medica, Inc.
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收藏
页码:1068 / 1073
页数:6
相关论文
共 30 条
[1]   Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency [J].
Abizaid, AS ;
Clark, CE ;
Mintz, GS ;
Dosa, S ;
Popma, JJ ;
Pichard, D ;
Satler, LF ;
Harvey, M ;
Kent, KM ;
Leon, MB .
AMERICAN JOURNAL OF CARDIOLOGY, 1999, 83 (02) :260-+
[2]   Acute renal failure in intensive care units - Causes, outcome, and prognostic factors of hospital mortality: A prospective, multicenter study [J].
Brivet, FG ;
Kleinknecht, DJ ;
Loirat, P ;
Landais, PJM ;
Bedock, B ;
Bleichner, G ;
Richard, C ;
Coste, F ;
BrunBuisson, C ;
Sicot, C ;
Tenaillon, A ;
Gajdos, P ;
Blin, F ;
Saulnier, F ;
Agostini, MM ;
Nicolas, F ;
FeryLemonnier, E ;
Staikowski, F ;
Carlet, J ;
Guivarch, G ;
Fraisse, F ;
Ricome, J ;
Tempe, JD ;
Mezzarobba, P .
CRITICAL CARE MEDICINE, 1996, 24 (02) :192-198
[3]   Independent association between acute renal failure and mortality following cardiac surgery [J].
Chertow, GM ;
Levy, EM ;
Hammermeister, KE ;
Grover, F ;
Daley, J .
AMERICAN JOURNAL OF MEDICINE, 1998, 104 (04) :343-348
[4]   PROGNOSTIC STRATIFICATION IN CRITICALLY ILL PATIENTS WITH ACUTE-RENAL-FAILURE REQUIRING DIALYSIS [J].
CHERTOW, GM ;
CHRISTIANSEN, CL ;
CLEARY, PD ;
MUNRO, C ;
LAZARUS, JM .
ARCHIVES OF INTERNAL MEDICINE, 1995, 155 (14) :1505-1511
[5]   DOSING OF CONTRAST MATERIAL TO PREVENT CONTRAST NEPHROPATHY IN PATIENTS WITH RENAL-DISEASE [J].
CIGARROA, RG ;
LANGE, RA ;
WILLIAMS, RH ;
HILLIS, LD .
AMERICAN JOURNAL OF MEDICINE, 1989, 86 (06) :649-652
[6]   PREDICTION OF CREATININE CLEARANCE FROM SERUM CREATININE [J].
COCKCROFT, DW ;
GAULT, MH .
NEPHRON, 1976, 16 (01) :31-41
[7]   ACC/AHA guidelines for Coronary Artery Bypass Graft Surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1991 Guidelines on Coronary Artery Bypass Graft Surgery) [J].
Eagle, KA ;
Guyton, RA ;
Davidoff, R ;
Ewy, GA ;
Fonger, S ;
Gardner, TJ ;
Gott, JP ;
Herrmann, HC ;
Marlow, RA ;
Nugent, WC ;
O'Connor, GT ;
Orszulak, TA ;
Rieselbach, RE ;
Winters, WL ;
Yusuf, S ;
Gibbons, RJ ;
Alpert, JS ;
Eagle, KA ;
Gardner, TJ ;
Garson, A ;
Gregoratos, G ;
Russell, RO ;
Smith, SC ;
McEntee, CW ;
Elma, MA ;
Pigman, GC ;
Starke, RD ;
Taubert, KA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999, 34 (04) :1262-1342
[8]   The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with pre-existent chronic renal insufficiency [J].
Gruberg, L ;
Mintz, GS ;
Mehran, R ;
Dangas, G ;
Lansky, AJ ;
Kent, KM ;
Pichard, AD ;
Satler, LF ;
Leon, MB .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (05) :1542-1548
[9]   Acute renal failure requiring dialysis after percutaneous coronary interventions [J].
Gruberg, L ;
Mehran, R ;
Dangas, G ;
Mintz, GS ;
Waksman, R ;
Kent, KM ;
Pichard, AD ;
Satler, LF ;
Wu, HS ;
Leon, MB .
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2001, 52 (04) :409-416
[10]   THE MEANING AND USE OF THE AREA UNDER A RECEIVER OPERATING CHARACTERISTIC (ROC) CURVE [J].
HANLEY, JA ;
MCNEIL, BJ .
RADIOLOGY, 1982, 143 (01) :29-36