Nephrotoxic Effects of Contrast Medium in Patients Undergoing Coronary Angiography and Percutaneous Coronary Intervention

Open Access

Abstract

Background: Contrast-induced nephropathy (CIN) is a significant complication of coronary angiography and percutaneous coronary intervention, leading to increased morbidity, prolonged hospital stay, and higher healthcare costs. Objective: The aim of the study was to evaluate the incidence, risk factors, and outcomes of CIN in patients undergoing these procedures. Method & Materials: This prospective, non-randomized clinical study enrolled 100 adults undergoing coronary angiography with or without PTCA at the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh (May 2007–April 2008). Non-ionic low-osmolar contrast (Iopamidol) was used, and serum creatinine was measured at baseline and days 1–3 and 7. The primary outcome was peak creatinine rise by day 3; secondary outcomes were rises ≥0.5 and ≥1.0 mg/dL. Statistical analyses used Student’s t-test and Chi-square test with p<0.05. Results: Among 100 patients undergoing coronary procedures, those with pre-existing renal impairment (n=50) versus normal function (n=50) had higher baseline creatinine (1.8±0.3 vs 1.1±0.2 mg/dL), more diabetes (70% vs 20%), greater creatinine rise at day 3 (0.39±0.24 vs 0.20±0.15 mg/dL), and higher CIN incidence (18% vs 2%) (all p<0.01). The 10 CIN cases occurred in older patients (67.4±4.9 vs 49.5±9.1 years) receiving higher contrast volumes (126.0±21.3 vs 104.3±35.8 ml). Age ≥70, contrast ≥100 ml, diabetes, renal impairment, and their combination were significant predictors (OR 1.24–2.89, all p<0.05). Most (96%) recovered within 3 weeks. Conclusion: Diabetic patients with pre-existing renal impairment, advanced age, and higher contrast volume are at the highest risk for contrast-induced nephropathy, which is usually reversible within two weeks.