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).
Fill in the Blanks: Q: “The diagnosis of type 2 MI is associated with a _____ prognosis. ___% of patients will live five years after their diagnosis.” The answer is a) POOR and b) a staggering 40%. I did not know that. However, what I am aware of is the ambiguity around Type 2 MIs and […]
What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… […]
As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc. Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them. If I am […]