Association Between Plasma Osmolality and Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Öz

Objective: Contrast-induced nephropathy (CIN) is a clinically relevant complication of percutaneous coronary intervention (PCI), particularly in acute coronary syndrome (ACS). Calculated plasma osmolality (PO), derived from routine laboratory measurements, may reflect fluid and solute disturbances associated with renal vulnerability. This study evaluated the relationship between admission PO and CIN in patients with ACS undergoing PCI. Methods: This retrospective, single-center study included 542 patients with ACS who underwent coronary angiography and PCI between January 2016 and December 2017. The cohort comprised 81 patients with unstable angina pectoris, 288 with non-ST-segment elevation myocardial infarction, and 173 with ST-segment elevation myocardial infarction. PO was calculated from admission sodium, glucose, and blood urea nitrogen levels. CIN was defined as an absolute increase of ≥0.5 mg/dL or a relative increase of ≥25% in serum creatinine within 72 hours after contrast exposure. Associated factors were examined using multivariable logistic regression. Results: CIN developed in 62 patients (11.4%). Admission PO was higher among patients who developed CIN than among those who did not (295.4 [290.9–302.3] vs. 287.7 [283.4–292.6] mOsm/kg H₂O, p<0.001). Patients with CIN were older and had higher potassium, baseline creatinine, and red cell distribution width, together with lower estimated glomerular filtration rate and left ventricular ejection fraction (LVEF). In the adjusted model, PO remained independently associated with CIN (OR: 1.070; 95% CI: 1.030–1.111; p=0.001). Potassium, baseline creatinine, and red cell distribution width were also independently associated with CIN, whereas LVEF showed an inverse association. Conclusions: Higher calculated admission PO was independently associated with CIN in patients with ACS undergoing PCI. This readily available parameter may contribute to renal risk assessment, although prospective studies are needed to establish its clinical utility and relevant thresholds. Keywords: Acute Coronary Syndrome; Percutaneous Coronary Intervention; Acute Kidney Injury; Contrast Media; Osmolar Concentration.

Anahtar Kelimeler

• Acute Coronary Syndrome
• Percutaneous Coronary Intervention
• Acute Kidney Injury
• Contrast Media
• Osmolar Concentration

Etik Beyan

This study is approved by the Ethical Committee of Çukurova University Faculty of Medicine (Approval No. 75, date: 02 March 2018). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

Teşekkür

We would like to thank Yusuf Kemal ARSLAN for his valuable assistance with the statistical analyses of this study.

Perkütan Koroner Girişim Uygulanan Akut Koroner Sendromlu Hastalarda Plazma Osmolalitesi ile Kontrast İlişkili Nefropati Arasındaki İlişki

Öz

**Amaç:** Kontrast ilişkili nefropati (KİN), özellikle akut koroner sendromlu (AKS) hastalarda perkütan koroner girişimin (PKG) klinik açıdan önemli bir komplikasyonudur. Rutin laboratuvar ölçümlerinden hesaplanan plazma osmolalitesi (PO), böbreğin hasara yatkınlığıyla ilişkili sıvı ve solüt dengesindeki bozuklukları yansıtabilir. Bu çalışmada, PKG uygulanan AKS hastalarında başvuru sırasındaki PO ile KİN arasındaki ilişki değerlendirildi. **Yöntemler:** Bu retrospektif, tek merkezli çalışmaya Ocak 2016 ile Aralık 2017 tarihleri arasında koroner anjiyografi ve PKG uygulanan 542 AKS hastası dahil edildi. Çalışma kohortu kararsız anjina pektorisli 81, ST-segment yükselmesiz miyokard enfarktüslü 288 ve ST-segment yükselmeli miyokard enfarktüslü 173 hastadan oluşuyordu. PO, başvuru sırasında ölçülen sodyum, glukoz ve kan üre azotu düzeyleri kullanılarak hesaplandı. KİN, kontrast madde uygulamasından sonraki 72 saat içinde serum kreatinin düzeyinde ≥0,5 mg/dL mutlak veya ≥%25 göreceli artış olarak tanımlandı. İlişkili faktörler çok değişkenli lojistik regresyon analiziyle incelendi. **Bulgular:** Altmış iki hastada (%11,4) KİN gelişti. Başvuru sırasındaki PO, KİN gelişen hastalarda gelişmeyenlere göre daha yüksekti (295,4 [290,9–302,3] ve 287,7 [283,4–292,6] mOsm/kg H₂O; *p*<0,001). KİN gelişen hastalar daha ileri yaştaydı; potasyum, başlangıç kreatinin ve eritrosit dağılım genişliği değerleri daha yüksek, tahmini glomerüler filtrasyon hızı (GFR)ve sol ventrikül ejeksiyon fraksiyonu (LVEF) ise daha düşüktü. Düzeltilmiş modelde PO, KİN ile bağımsız olarak ilişkili kalmaya devam etti (OR: 1,070; %95 GA: 1,030–1,111; *p*=0,001). Potasyum, başlangıç kreatinin düzeyi ve eritrosit dağılım genişliği de KİN ile bağımsız olarak ilişkiliyken LVEF ile KİN arasında ters yönlü bir ilişki saptandı. **Sonuç:** PKG uygulanan AKS hastalarında, başvuru sırasında hesaplanan yüksek PO değeri KİN ile bağımsız olarak ilişkiliydi. Kolaylıkla hesaplanabilen bu parametre, renal risk değerlendirmesine katkı sağlayabilir; ancak klinik yararının ve ilgili eşik değerlerin belirlenmesi için prospektif çalışmalara ihtiyaç vardır. **Anahtar kelimeler:** Akut Koroner Sendrom; Perkütan Koroner Girişim; Akut Böbrek Hasarı; Kontrast Maddeler; Osmolar Konsantrasyon.

Anahtar Kelimeler

• Akut Koroner Sendrom
• Perkütan Koroner Girişim
• akut Böbrek Hasarı
• Kontrast Maddeler
• Osmolar Konsantrasyon

Etik Beyan

Bu çalışma Çukurova Üniversitesi Tıp Fakültesi Etik Kurulu tarafından onaylanmıştır (Onay No. 75, tarih: 02 Mart 2018). Çalışma, Helsinki Bildirgesi'nde belirtilen etik ilkelere uygun olarak yürütülmüştür.

Teşekkür

Bu çalışmanın istatistiksel analizlerindeki değerli yardımları için Yusuf Kemal ARSLAN'a teşekkür ederiz.

Kaynakça

1. Mehran R, Dangas GD, Weisbord SD. Contrast-associated acute kidney injury. N Engl J Med. 2019;380(22):2146–2155. doi:10.1056/NEJMra1805256.
2. James MT, Samuel SM, Manning MA, et al. Contrast-induced acute kidney injury and risk of adverse clinical outcomes after coronary angiography: a systematic review and meta-analysis. Circ Cardiovasc Interv. 2013;6(1):37–43. doi:10.1161/CIRCINTERVENTIONS.112.974493.
3. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393–1399. doi:10.1016/j.jacc.2004.06.068.
4. Tatlisu MA, Kaya A, Keskin M, et al. Can we use plasma hyperosmolality as a predictor of mortality for ST-segment elevation myocardial infarction? Coron Artery Dis. 2017;28(1):70–76. doi:10.1097/MCA.0000000000000426.
5. Farhan S, Vogel B, Baber U, et al. Calculated serum osmolality, acute kidney injury, and relationship to mortality after percutaneous coronary intervention. Cardiorenal Med. 2019;9(3):160–167. doi:10.1159/000494807.
6. Yildiz I, Yildiz PO, Rencuzogullari I, et al. Association of serum osmolarity with contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction. Angiology. 2019;70(7):627–632. doi:10.1177/0003319719826466.
7. Kanbay M, Siriopol D, Ozdogan E, et al. Serum osmolarity as a potential predictor for contrast-induced nephropathy following elective coronary angiography. Int Urol Nephrol. 2020;52(3):541–547. doi:10.1007/s11255-020-02391-4.
8. Samir A, Radwan A, Elhossary H, et al. Predictive ability of serum osmolarity for contrast-induced nephropathy after elective percutaneous coronary intervention: Are we having a new target? Egypt Heart J. 2025;77:22. doi:10.1186/s43044-025-00620-8.

9. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009 May 5;150(9):604-12. doi: 10.7326/0003-4819-150-9-200905050-00006.
10. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277–314. doi:10.1016/j.echo.2016.01.011.
11. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39.e14. doi: 10.1016/j.echo.2014.10.003.
12. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2014;63(22):e57–e185. doi: 10.1016/j.jacc.2014.02.536.
13. Wu MY, Lo WC, Wu YC, et al. The incidence of contrast-induced nephropathy and the need of dialysis in patients receiving angiography: a systematic review and meta-analysis. Front Med (Lausanne). 2022;9:862534. doi:10.3389/fmed.2022.862534
14. Mehran R, Owen R, Chiarito M, et al. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet. 2021;398(10315):1974–1983. doi:10.1016/S0140-6736(21)02326-6.
15. Kusirisin P, Chattipakorn SC, Chattipakorn N. Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches. J Transl Med. 2020;18:400. doi:10.1186/s12967-020-02574-8.
16. Zhang L, Cao X, Yang Y, et al. Risk prediction models for contrast-induced acute kidney injury in patients with acute coronary syndromes: a systematic review and meta-analysis. Front Med (Lausanne). 2025;12:1629369. doi:10.3389/fmed.2025.1629369.
17. Kurtul A, Yarlioglues M, Murat SN, et al. Red cell distribution width predicts contrast-induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Angiology. 2015;66(5):433–440. doi:10.1177/0003319714535238.
18. Wu X, Ma C, Sun D, et al. Inflammatory indicators and hematological indices in contrast-induced nephropathy among patients receiving coronary intervention: a systematic review and meta-analysis. Angiology. 2021;72(9):867–877. doi:10.1177/00033197211000492.
19. Liang W, Yu CJ, Wang QY, et al. Anemia is associated with increased risk of contrast-induced acute kidney injury: a systematic review and meta-analysis. Bioengineered. 2021;12(1):648–661. doi:10.1080/21655979.2021.1883887.
20. Lucreziotti S, Centola M, Salerno-Uriarte D, et al. Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevation myocardial infarction. Int J Cardiol. 2014;174(1):37–42. doi:10.1016/j.ijcard.2014.03.087.
21. Hu Y, Wang X, Xiao S, et al. A clinical nomogram based on the triglyceride-glucose index to predict contrast-induced acute kidney injury after percutaneous intervention in patients with acute coronary syndrome with diabetes mellitus. Cardiovasc Ther. 2022;2022:5443880. doi:10.1155/2022/5443880.
22. Zhu R, Zheng R, Deng B, et al. Liu P, Wang Y. Association of N-acetylcysteine use with contrast-induced nephropathy: an umbrella review of meta-analyses of randomized clinical trials. Front Med (Lausanne). 2023;10:1235023. doi:10.3389/fmed.2023.1235023.