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      Metabolic Syndrome as a Risk Factor for Contrast-Induced Nephropathy in Non-Diabetic Elderly Patients with Renal Impairment

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          Abstract

          Background/Aims: Metabolic syndrome (MS) as a risk factor for contrast-induced nephropathy (CIN) has not been studied. The aim of the present study was to assess the influence of MS on the development of CIN in patients undergoing coronary angiography. Methods: This was a prospective cohort study. A total of 219 non-diabetic patients with reduced kidney function and age ≧60 years were divided into two groups (MS, n = 107 and non-MS, n = 112). CIN was defined as an increase of ≧25% in creatinine over the baseline value within 48 h of angiography. Results: CIN occurred in 14% of the MS group and 3.6% of the non-MS group (p = 0.006). Serum creatinine increased from 1.06 ± 0.17 to 1.12 ± 0.27 mg/dl in the MS group and from 1.03 ± 0.17 to 1.09 ± 0.23 mg/dl in the non-MS group (p < 0.001). MS was a risk indicator of CIN [odds ratio (OR) 4.26; 95% confidence interval (95% CI) 1.19–15.25; p = 0.026). Impaired fasting glucose (OR 4.72; 95% CI 1.53–14.56; p = 0.007), high triglyceride (OR 4.06; 95% CI 1.22–13.44; p = 0.022), and multivessel involvement (OR 3.14; 95% CI 1.07–9.82; p = 0.038) in the MS group were predictors of CIN. Conclusion: Our data support the hypothesis that patients with MS are at risk of developing CIN.

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          Most cited references 19

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          Prevalence of the Metabolic Syndrome Among US Adults

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            The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm.

            The metabolic syndrome is associated with an increased risk of cardiovascular disease in patients without a cardiovascular history. We investigated whether the metabolic syndrome is related to the extent of vascular damage in patients with various manifestations of vascular disease. The study population of this cross-sectional survey consisted of 502 patients recently diagnosed with coronary heart disease (CHD), 236 with stroke, 218 with peripheral arterial disease (PAD) and 89 with abdominal aortic aneurysm (AAA). Metabolic syndrome was diagnosed according to Adult Treatment Panel III criteria. Carotid Intima Media Thickness (IMT), Ankle Brachial Pressure Index (ABPI) and albuminuria were used as non-invasive markers of vascular damage and adjusted for age and sex if appropriate. The prevalence of the metabolic syndrome in the study population was 45%. In PAD patients this was 57%; in CHD patients 40%, in stroke patients 43% and in AAA patients 45%. Patients with the metabolic syndrome had an increased mean IMT (0.98 vs 0.92mm, P-value <0.01), more often a decreased ABPI (14% vs 10%, P-value 0.06) and increased prevalence of albuminuria (20% vs 15%, P-value 0.03) compared to patients without this syndrome. An increase in the number of components of the metabolic syndrome was associated with an increase in mean IMT (P-value for trend <0.001), lower ABPI (P-value for trend <0.01) and higher prevalence albuminuria (P-value for trend <0.01). In patients with manifest vascular disease the presence of the metabolic syndrome is associated with advanced vascular damage.
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              Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older. A prospective study.

              To evaluate the incidence, risk factors, and clinical course of radiocontrast nephrotoxic effects in the elderly, 183 patients aged 70 years or more undergoing 199 cardiac catheterizations were studied prospectively. Contrast nephropathy (a rise in creatinine level of greater than or equal to 44 mumol/L above baseline) occurred in 21 cases (11%). In 16 (76%) of these 21 cases, renal function returned toward baseline within several days. One patient developed transient oliguria, but no deaths were attributable to renal failure. Independent risk factors for renal dysfunction included contrast volume greater than 200 mL, serum albumin level less than 35 g/L, diabetes mellitus, serum sodium level less than 135 mmol/L, and baseline creatinine level greater than 133 mumol/L. Renal insufficiency occurred in 1.2% of patients with no risk factors, 11.2% of those with one risk factor, and more than 20% of those with two or more risk factors. Thus, the incidence and clinical course of radiocontrast nephropathy in the elderly are similar to those in younger patients. High-risk elderly patients who may benefit from more aggressive prophylaxis can be prospectively identified, but the threat of contrast nephrotoxic effects should not be considered a major contraindication to angiography in appropriately selected patients.
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                Author and article information

                Journal
                KBR
                Kidney Blood Press Res
                10.1159/issn.1420-4096
                Kidney and Blood Pressure Research
                S. Karger AG
                1420-4096
                1423-0143
                2006
                June 2006
                06 June 2006
                : 29
                : 1
                : 2-9
                Affiliations
                Departments of aNephrology, bFirst Cardiology, and cRadiology, Ataturk Training and Research Hospital, Izmir, Turkey; dDepartment of Medicine, Division of Nephrology and eDepartment of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tenn., USA
                Article
                92481 Kidney Blood Press Res 2006;29:2–9
                10.1159/000092481
                16582571
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 3, References: 32, Pages: 8
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/92481
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