Early Creatinine Shifts Predict Contrast-induced Nephropathy and Persistent Renal Damage after Angiography

PURPOSE: The purpose of this study was to evaluate incidence and predictors of contrast-induced nephropathy after coronary angiography and interventions, and to assess renal function at 30 days. The prognostic value of any early shift of serum creatinine compared with baseline was investigated; such measurement, being a delta, is largely independent of creatinine variations. METHODS: There were 216 patients at risk for contrast-induced nephropathy prospectively evaluated at baseline and at 12, 24, and 48 hours after exposure to contrast media, and 190 (88%) evaluated 1 month after discharge. RESULTS: Contrast-induced nephropathy occurred in 39 patients (18%), and 30-day renal damage was detected in 15 (7%). Contrast media/kg volume predicted contrast-induced nephropathy (P = .002), and percentage change of creatinine 12 hours from baseline was significantly higher in patients with nephropathy (P < .001). At multivariate analysis, percentage change of creatinine 12 hour-basal was the best predictor of nephropathy (P < .001). A 5% increase of its value yielded 75% sensitivity and 72% specificity (area under the curve 0.80; odds ratio 7.37; 95% confidence interval, 3.34-16.23) for early contrast-induced nephropathy detection. Furthermore, it strongly correlated with the development of renal impairment at 30 days (P = .002; sensitivity 87%, specificity 70%; area under the curve 0.85; odds ratio 13.29; 95% confidence interval, 2.91-60.64). CONCLUSION: Minimal elevations of serum creatinine at 12 hours are highly predictive of contrast-induced nephropathy and 30-day renal damage after exposure to contrast media. (C) 2010 Elsevier Inc. All rights reserved. The American Journal of Medicine (2010) 123, 755-763