Predictors of worsening renal function after computed tomography coronary angiography: Assessed by cystatin C
Journal of Cardiovascular Computed Tomography (2012) 6, 31-36
Hirohiko Ando, MD, Satoshi Isobe, MD, PhD, Tetsuya Amano, MD, PhD, Takashi Yamada, MD, Hiroko Ohtsubo, RN, Miyuki Yuba, RN, Hideki Ishii, MD, PhD, Toyoaki Murohara, MD, PhD
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 HbAlc (r = 0.38, P < 0.001). Multiple regression analysis showed that oral fluid intake (p = -0.796, P < 0.0001) and HbAlc (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 HbAlc. 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. © 2012 Society of Cardiovascular Computed Tomography. All rights reserved.