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The Effects of Contrast Media on Renal Function in Patients Undergoing Coronary CT Angiography

Author: HuangJian
Tutor: LiuJun
School: Dalian Medical University
Course: Internal Medicine
Keywords: Cystatin C Renal function Coronary CTA Contrast-induced nephropathy
CLC: R541.4
Type: Master's thesis
Year: 2013
Downloads: 7
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Abstract


Background and Objective: With the improvement of people’s living conditions, theincidence and mortality rate of cardiovascular disease, especially coronary heartdisease (CHD) are rising year by year. Coronary angiography has long been consideredthe "gold standard" for the diagnosis of CHD. But contrast nephropathy has raisedclinicians’ close concern, and most of the patients with CHD, when undergoingcoronary angiography, are reluctant to accept it. The coronary computed tomographyangiography (CTA) is becoming more and more widely applied in clinical practice toscreen CHD. Coronary CTA is a kind of enhanced CT examination, in which contrastagent is necessary. Nowadays, contrast-induced nephropathy (CIN) has become amajor cause of renal insufficiency. At present, the commonly used indexes for theevaluation of renal insufficiency are serum creatinine, glomerular filtration rate. Inrecent years, Cystain C is wildly focused and considered a more sensitive endogenousmarker for the early evaluation of kidney injury. The concentration of Cystain C inblood is influenced by glomerular filtration rate, and dependent on the external factors.Therefore, it is an ideal index of glomerular filtration rate. This paper aims to analyzethe changes in patients’ renal function before and after coronary CTA and reveals theeffects of contrast agents on renal function at early stage.Methods: In this retrospective study,81cases of patients undergoing coronary CTAexamination were analyzed. They were randomly divided into the simple diabetesmellitus group, the simple hypertension group, the diabetes mellitus and hypertensiongroup. The differences in serum creatinine (Cre), plasma Cystatin C (Cys C), andestimated glomerular filtration rate (eGFR) were compared before and after theexamination.Results: The81subjects (44males (54.3%) and37females (45.7%), mean age:62.5±10.0years), included16diabetic patients,35patients with simple hypertension,13patients with both diabetes mellitus and hypertension. Among them,42patients applied ACEI/ARB before the check,79cases received statins,3cases had chronicrenal insufficiency (eGFR <60ml/min·1.73m2), and1case had chronic renalinsufficiency combined with diabetes mellitus and hypertension. There was nosignificant difference in the clinical data between different groups. The difference inCre and eGFR before and24hours after coronary CTA examination was notstatistically significant (P=0.647and P=0.276, respectively). However, CysC rosesignificantly24hours after the check (P=0.008), all were within the normalrange.None developed CIN. CysC and Cre had significant positive correlation (r=0.691, P <0.001). In addition, CysC and eGFR were significantly negativelycorrelated (P <0.001and r=-0.670). Cre and eGFR had significant positivecorrelation(r=0.769, P <0.001). There was no significant difference in the renalfunction (Cre, CysC, eGFR) in those16patients with diabetes mellitus (P>0.05), inthose35patients with simple hypertension (P>0.05) or in those13cases with bothhypertension and diabetes mellitus (P>0.05) before and after the check. Pearson’ slinear regression of analysis showed that the change in CysC levels24hours aftercoronary CTA has no correlation with age (F=3.452，P=0.067＞0.05). Multi-factorstepwise regression analysis indicated the change of CysC24hours after theexamination, was not correlated with diabetes, high blood pressure (P>0.05).However, gender, age, Cre and basic eGFR were the risk factors of the change of CysC24hours after examination (P <0.05).Conclusion: The increase of CysC level was more remarkable than that of Cre24hours after the administration of contrast medium, which indicated that CysC is moresensitive to the kidney injury after coronary CTA when compared with Cre. Gender,age, Cre and basic eGFR are the risk factors of the change in CysC levels24hoursafter the examination. It is relatively safe for patients with normal renal function,hypertension, and diabetes mellitus to apply the contrast during coronary CTA.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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