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Abstract 14808: Acute Kidney Injury and Adverse Outcomes in Patients Undergoing Right Heart Catheterization versus Patients Undergoing Right and Left Heart Catheterization and Coronary Angiography

Authors :
Sumon Roy
Robert A. Perera
Ion S. Jovin
Ravi Choxi
Annette Min
Melissa Wasilewski
Source :
Circulation. 142
Publication Year :
2020
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2020.

Abstract

Background: Contrast induced nephropathy (CIN), or contrast-induced acute kidney injury is considered a complication of intravascular administration of iodinated contrast material. However, more recent studies have challenged the reported incidence of contrast nephropathy. We compared the incidence of acute kidney injury and of nephropathy at 3 months in patients undergoing only right heart catheterization (RHC) to patients undergoing right and left heart catheterization (R&LHC) and coronary angiography. Methods and Results: We studied 1779 consecutive patients at a Veterans Administration Medical Center, of which 869 underwent only RHC, which does not involve the administration of iodinated contrast media, and 910 patients who underwent R&LHC and coronary angiography. Creatinine values at 72 hours after the respective procedure were available in 938 patients and creatinine values at 3 months were available in 1246 patients. The incidence of acute kidney injury (defined as an increase in serum creatinine of 0.5 mg/dL or 25% compared to baseline) at 3 days was 34 (7.5%) in the RHC group and 46 (9.5%) in the R&LHC group (P=0.31). The incidence of nephropathy at 3 months was 89 (15.6%) in the RHC group and 113 (12.2%) in the R&LHC group (P=0.15). On multivariable analysis including adjustment for a propensity score, CIN at 3 days was not significantly associated with R&LHC (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.98-1.05; P=0.56) and neither was nephropathy at 3 months (OR 1.01, 95% CI 0.98-1.04; P=0.22). Patients undergoing R&LHC had a lower mortality at 12 months (hazard ratio 0.57, 95% CI 0.43-0.77; P Conclusions: The incidence of acute kidney injury was not significantly different in patients undergoing RHC compared to patients undergoing R&LHC and coronary angiography, even though the former received no contrast dye. The incidence of nephropathy at 3 months was also not significantly different between the two groups while mortality was significantly lower in the group of patients undergoing R&LHC. This suggests that serum creatinine is a nonspecific diagnostic marker for contrast induced-kidney injury and that long-term outcomes are not associated with the administration of contrast in this population.

Details

ISSN :
15244539 and 00097322
Volume :
142
Database :
OpenAIRE
Journal :
Circulation
Accession number :
edsair.doi...........dddf0362b4b58bcfc7d59056410983cc
Full Text :
https://doi.org/10.1161/circ.142.suppl_3.14808