The prevalence of contrast nephropathy in patients undergoing percutaneous coronary intervention in acute coronary syndrome

Yıl 2018, Cilt: 1 Sayı: 2, 34 - 39, 30.06.2018

Muhammed Karadeniz , Hüseyin Kandemir , Taner Sarak , Çağlar Alp

https://doi.org/10.32322/jhsm.410522

Cited By: 2

Öz

Objective: Contrast nephropathy (KMN) is
defined as an acute renal injury due to intravenous contrast agents applied in
diagnostic or therapeutic interventions and is an important cause of
hospitalization due to acute renal failure. In this study, the frequency of
coronary intervention and contrast agent nephropathy was investigated in acute
coronary syndrome.

Material and Method: According
to the European Urogenital Radiology Society Guide, "An increase of 25 or
0.5 mg/dl in serum creatinine within 3 days after administration of contrast
medium without any other etiological cause". After approval of the Ethics
Committee, 336 patients who met the inclusion criteria were included in the
study. Patients younger than 18 years of age with chronic renal insufficiency,
heart failure, coronary by-pass history, serum creatinine control after the
procedure and patients without percutaneous coronary intervention were excluded
from the study.

Results: BMD was detected in 11.9% of the 336
patients included in the study. The mean age of 40 patients who developed CMN
was 73.9±10.2 / year, and the mean age of 296 patients who did not have CMN was
59.4±12.3 /year. The mean age was significantly higher in the DM group (p
<0.001). The mean body mass index (BMI) was 28.2 ± 4.7kg / m² in the
non-developing group, while the BMI average was 26.5 ± 3.3kg / m². The mean VKI
was lower in the DM group (p = 0.044). The mean SYNTAX score was 16.6 ± 8.3 in
the non-developing group, whereas the mean in the group with the improved KMN
was 22.5 ± 10.3. The SYNTAX score was higher in the KMN-developing group than
in the non-KMN group (p=0.001). There was no difference between two groups in
terms of AKS type, DM, HT and sex (p=0.713, p=0.317, p=0.055, p=0.589).

Conclusion: Strategies should be implemented to
prevent other CMD developments, provided that hydration is absolute before and
after the procedure in groups at risk for which contrast media should be given.

Anahtar Kelimeler

Contrast nephropathy, acute coronary syndrome, percutaneous coronary intervention

Akut koroner sendromda perkütan koroner girişim yapılan hastalarda kontrast nefropati prevalansı

Öz

Amaç: Kontrast madde
nefropatisi (KMN), tanı veya tedavi
amaçlı yapılan girişimlerde uygulanan intravenöz kontrast ajanlara bağlı olarak
gelişen akut böbrek hasarı olarak tanımlanmıştır ve akut böbrek yetersizliğine
bağlı olarak hastaneye yatışlarda önemli bir nedendir. Bu çalışmada akut
koroner sendromda koroner girişim ve kontrast madde nefropatisi sıklığı
araştırılmıştır.

Gereç ve Yöntem: Avrupa Ürogenital Radyoloji Cemiyeti Kılavuzu’na göre KMN tanımı; “başka
bir etiyolojik sebep olmaksızın, kontrast madde verilmesinden sonraki 3 gün
içinde serum kreatinin düzeyinde başl25 veya 0.5 mg/dl artış olması” olarak
kabul edilmiştir. Etik Kurul onayı sonrası dahil edilme
kriterlerine uyan 336 hasta çalışmaya alındı. 18 yaşından küçük, kronik böbrek
yetersizliği olan, kalp yetmezliği olan, koroner by-pass öyküsü olan, işlem
sonrası serum kreatinini kontrol edilemeyen hastalar ve perkütan koroner
girişim yapılmayan hastalar çalışma dışı bırakıldı.

Sonuçlar: Çalışmaya dahil edilen 336 hastanın %11,9’unda
KMN saptandı. KMN gelişen 40 hastanın yaş ortalaması 73,9±10,2/yıl, KMN
gelişmeyen 296 hastanın yaş ortalaması 59,4±12,3/yıl idi. KMN gelişen grupta
yaş ortalaması istatistiksel olarak anlamlı derecede yüksek bulundu
(p<0.001). KMN gelişmeyen hasta grubunda vücut kitle indeksi (VKİ)
ortalaması 28,2±4,7kg/m² iken, KMN gelişen grupta VKİ ortalaması 26,5±3.3kg/m²
idi. KMN gelişen grupta VKİ ortalaması daha düşük bulundu (p=0.044). KMN gelişmeyen
hasta grubunda SYNTAX skoru ortalama 16,6±8,3 iken, KMN gelişen hasta grubunda
ortalama 22,5±10,3 idi. KMN gelişen grupta SYNTAX skoru KMN gelişmeyen gruba
göre daha yüksek bulundu (p=0.001). AKS tipi, DM, HT ve cinsiyet açısından iki
grup arasında fark bulunmadı (p=0.713, p=0.317,p=0.055, p=0.589).

Sonuç: Kontrast madde verilmesi gereken risk altındaki
gruplarda işlem öncesinde ve sonrasında hidrasyon mutlak olması şartıyla diğer
KMN gelişmesini önleyici stratejiler uygulanmalıdır.

Anahtar Kelimeler

Kontrast nefropati, akut koroner sendrom, perkütan koroner girişim

Kaynakça

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