Incidence, Risk Factors and Outcome of Contrast Induced Nephropathy after Percutaneous Coronary Intervention at a Tertiary Hospital in Oman: Call for Novel Preventive Measures

Khandaker AM AM, Panduranga P, Shournoby KH and Salmi I

Published on: 2024-08-15

Abstract

Objective: The aim of this study was to assess the incidence, risk factors and short-term outcome (30 days) of contrast induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI) in a tertiary hospital in Oman either due to acute or chronic coronary syndromes.

Methods: A prospective cohort study from June, 2020 to May 2021. All patients > 18 years undergoing PCI who had a serum creatinine measurement prior to PCI, 48 hours after PCI and at 30 days were eligible for the study. All the patients were on standard preventive measure of hydration with normal saline as recommended in guidelines. The CIN risk was predicted using Mehran risk prediction scale (MRS). All observed differences between CIN group and non-CIN group were considered significant if p < 0.05.

Results: A total of 154 patients were included in the study. Incidence of in-hospital CIN was 7.1% (n=11). CIN needing dialysis during index admission was seen in 1.3 %( n=2) and no patients needed dialysis at 30 days. Persistent CIN at 30 days was noted in 1.3% (n=2). There was no mortality. The predominant risk factors for CIN were old age (67.8±11 vs 60.6±10), diabetes mellitus (90.9% vs 50.3%), anemia (81.8% vs 29.4%), heart failure (81.8% vs18.2), eGFR < 60 ml/min/1.73m2 and increasing MRS of > 11, all with significant p value and they persisted in univariate and multivariate analysis as well. With regard to MRS there was underestimation (11-16 score) and overestimation (>17 score) of predicted CIN percentage.

Conclusion: The overall incidence of CIN in this study was similar to other studies, but was high in those patients with risk factors. In addition, need for renal replacement therapy during index admission was high. The use of Mehran CIN risk score was able to identify patients with a high likelihood of CIN. Common preventive strategy of hydration with normal saline was found to be inadequate in preventing CIN in high risk group. Hence, in a tertiary institute with high volume PCI it is a call for additional novel precautions in preventing CIN.