Contrast induced nephropathy (CIN) has become a major issue in hospitalized patients. In this single center observational cohort of 561 patients undergoing primary PCI for STEMI, 21% of them developed CIN (defined as creatinine increase of 25% above baseline; 13% developed as defined by an absolute increase in creatinine by 0.5mg/dL), of which 12% required hemofiltration or dialysis. CIN occurred in 35% of those with renal insufficiency and 14% of those with normal renal function, and was significantly correlated with contrast volume. Mortality was 21% in those that developed CIN and 1% in those that did not. Although this study does not prove causation (that contrast caused the CIN or higher mortality), it reminds us of the frequency of CIN (even in those with normal baseline renal function), and reinforces the need for (albeit imperfect) preventive strategies (volume expansion, bicarbonate, maybe N-acetylcysteine, and avoiding all nephrotoxins) (abstract).
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.