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Predictors of worsening renal function after computed tomography coronary angiography: Assessed by cystatin C.
MedLine Citation:
PMID:  22210534     Owner:  NLM     Status:  Publisher    
BACKGROUND: An increase in cystatin C (CyC) of ≥10% for 24 hours may predict contrast-induced nephropathy and worse outcomes in patients with renal dysfunction undergoing invasive coronary angiography. OBJECTIVE: We investigated the changes in CyC in patients with preserved renal function referred for contrast-enhanced coronary computed tomography angiography (CTA). METHODS: We studied 151 patients undergoing CTA with 70 mL of iopamidol. Serum creatinine and CyC, a sensitive measure of renal dysfunction, shown to be associated with adverse outcomes, were measured 1 day and 1 week after CTA, respectively. The percentage change in CyC (%CyC) was determined and evaluated in comparison to fluid intake. RESULTS: The patients were dichotomized into 2 groups: 47 patients had ≥10% increase in CyC 1 day after CTA (group A) and 104 did not (group B). The percentage of diabetic patients, hemoglobin A1c (HbA1c), and the CyC levels at 1 week were significantly greater, and the oral fluid volume was significantly lower in group A than in group B. The %CyC inversely correlated with oral fluid volume (r = -0.80, P < 0.0001) and positively with HbA1c (r = 0.38, P < 0.001). Multiple regression analysis showed that oral fluid intake (β = -0.796, P < 0.0001) and HbA1c (β = 0.128, P = 0.007) are independent predictors for %CyC of ≥10%. CONCLUSION: Frequency of CyC elevation was strongly related to hydration after the study and also weakly related to HbA1c. Sufficient oral fluid intake (oral fluid volume/kg ≥ 20 mL/kg) is crucial, particularly for poorly controlled diabetic patients referred for CTA even though they show preserved renal function.
Hirohiko Ando; Satoshi Isobe; Tetsuya Amano; Takashi Yamada; Hiroko Ohtsubo; Miyuki Yuba; Hideki Ishii; Toyoaki Murohara
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-18
Journal Detail:
Title:  Journal of cardiovascular computed tomography     Volume:  -     ISSN:  1876-861X     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2012-1-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101308347     Medline TA:  J Cardiovasc Comput Tomogr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Department of Cardiology, Kami-iida Dai-ichi General Hospital, 2-70 Kami-iida, Kita-machi, Kita-ku, Nagoya, 462-0802, Japan; Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan.
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