Incidence of Contrast induced Nephropathy and risk factors among Patients undergoing Coronary Intervention at the Uganda Heart Institute

Abstract

Introduction: Contrast Induced Acute Kidney Injury (CIAKI) is the 3rd commonest cause of hospital acquired acute kidney injury and one of the main complications of coronary interventions. With the growing need of coronary interventions including the use of contrast in diagnostic and therapeutic measures, there is need to understand the risk of inducing CIAKI and appreciate the factors associated with CIAKI in order to devise control measures. We determined the incidence and risk factors associated with CIAKI in patients undergoing coronary interventions at the Uganda Heart institute (UHI). Objective: To determine the incidence and risk factors associated with developing CIAKI among patients undergoing coronary interventions at the UHI. Methodology: We conducted a prospective single cohort study. We consecutively enrolled consenting adult patients aged 18 years and above, undergoing coronary interventions at the UHI. At enrollment, pre-tested structured questionnaires were administered to collect history and clinical examination findings of the participants. Blood samples were drawn prior to and 48hrs after the intervention to assess for changes in serum creatinine. The data collected was entered into EPI DATA and then exported to STATA for analysis. The main outcome was incidence of CIAKI defined as an increase of 0.5mg/dl and more or 25% increase in serum creatinine at 48hours after exposure compared to the baseline. Risk factors were determined using logistic regression. Results: The mean age of the participants was 61.7 years (SD 12.) Majority male 138(65.7%) being male and overweight 97(46.1%). The incidence of CIAKI was estimated at 8.5% (17/201). Two factors were significantly associated with an increased risk of CIAKI; 1) having chronic xiv

kidney disease defined by an EGFR < 60mL/min per 1.73 m 2 (OR, 5.73; 95% CI, 1.874-17.514; P=0.002) and an elevated HBA1C ≥6.5% (Diabetes Mellitus) (OR, 3.46; 95% CI, 1.181-10.153; P=0.024). Conclusion: In this population of patients receiving coronary intervention, almost one in every ten patients developed CIAKI. The risk of CIAKI was greater in patients with chronic kidney disease and elevated Diabetes Mellitus Recommendations: We recommend that the clinicians providing coronary intervention consider the risk of development of CIAKI especially in patients with diabetes mellitus and chronic kidney disease endeavouring to prevent it as well as looking out for it.