ALBUMINURIA VS SERUM CREATININE AS A MARKER OF CONTRAST INDUCED NEPHROPATHY IN CASES WITH NORMAL OR LOW HEMOGLOBIN UNDERGOING PERCULTANEOUS CORONARY INTERVENTION

Abstract

Background An increase in the use of iodinated contrast media occasionally causes contrast-induced nephropathy (CIN) in patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI).With wide application of Percutaneous coronary intervention (PCI) technique in patients with coronary artery disease, contrast-induced acute kidney injury has become a serious complication. Hemoglobin has a significant impact on occurrence of CIN after PCI. Moreover due to variation of serum creatinine among patients of different weight, age, gender, volume status etc , it has some limitations in identifying CIN so role of some other potential marker like albuminuria should be established .But scarce data is available in this regard. Therefore we planned this study.

Objective To determine contrast induce nephropathy in cases with normal or low hemoglobin undergoing percutaneous coronary intervention.

To determine whether creatinine or albuminuria is a better biomarker of contrast-induced nephropathy in patients with normal or low hemoglobin level undergoing percutaneous coronary intervention

Material and methods

Study design: Comparative cross-sectional study

Setting: Department of Cardiology, Mayo Hospital Lahore.

Study duration: Six months

Data Collection Methodology

One hundred patients were included and divided into 2 groups like Group-A (normal Hb level) and Group-B (low Hb level). Demographic data such as age, sex, height (cm), weight (kg), BMI (kg/m2) and other risk factors was recorded .Volume of contrast medium was recorded. Serum creatinine and albuminuria were measured 24hrs before and 48 hours after PCI. In case of raised serum creatinine level or albuminuria level, renal impairment (CIN) was labeled. All data was collected in data collection form. Data was analyzed in SPSS v. 22.0. Chi-square test will be applied to compare CIN in both study groups, taking p-value ≤ 0.05 as significant.

Results In patients with low Hb, mean age was 47.72±6.64 years. In patients with normal Hb, mean age was 48.78±6.03 years. In patients with low Hb, there were 36 (72.0%) males and 14 (28.0%) females. In patients with normal Hb, there were 30 (60.0%) males and 20 (40.0%) females. In patients with low Hb, the mean serum creatinine level was 1.04±0.23 mg/dl at baseline, which was increased to 1.48±0.43 mg/dl after 24 hours of PCI. In patient with normal Hb, mean creatinine level was 1.07±0.22 mg/dl, which was increased to 1.31±0.27 mg/dl (p<0.05). In patients with low Hb, CIN was positive in 17 (34.0%) cases while in patients with normal Hb only 8 (16.0%) cases had CIN (p<0.05). In patients with low Hb, mean albuminuria level was 40.88±7.27 mg/g at baseline, which was increased to 47.34±13.81 mg/g after 48 hours. In patients with normal Hb, mean albuminuria level was 38.36±4.94 mg/g at baseline, which was increased to 43.43±9.79 mg/g after 48 hours (p>0.05). CIN was positive in 20 (40.0%) cases in patients with low Hb while in 9 (18.0%) cases who had normal Hb (p<0.05).

Conclusion CIN was statistically significantly associated with low HB after administering contrast media in PCI. It was also found in a current study that serum creatinine was a better indicator than Albuminuria for detection of CIN.