Nephroprotection prevents incidence of AKI in patients undergoing elective percutaneous coronary interventions

Abstract

Introduction. It has been described that acute kidney injury due to contrast administration is a common complication after coronary angiography, particularly for high risk patients. The aim of this study was to confirm if current radiocontrast preventive strategy is protective in patients who undergo elective coronary angiography. Methods. The study included 43 consecutive patients who underwent elective coronary angiography. Patients were divided into subgroups regarding diabetes, age and presence of chronic renal failure. All patients received standard nephroprotective prevention: pre and post-interventional hydration (0.9% saline), N acetyl cystein (600 mg bid, PO), statins (10-20 mg bid, PO), vitamin C (500 mg IV) and iso-osmolar contrast media (Iodixanol- Visipaque), at a dose of 70-100 ml per procedure. Renal function was determined by Cockroft-Gault equation for estimation of Creatinine clearance (CCl) and early marker of acute kidney injury; neutrophil gelatinase-associated lipocalin (NGAL) was measured in urine by using automated platform ARCHITECT (Abbott Diagnostics). Results. After coronary angiography, CCl and urinary NGAL levels did not change significantly as compared with baseline values in all groups of patients. Also, renal function remained stable after coronary angiography in the subgroup of patients with diabetes, pre-existent chronic renal failure and in the subgroup of elderly patients (>65 years). Conclusions. Nephroprotective measures including isotonic contrasts prevent acute kidney injury even in highrisk groups of patients. We need more investigations comprising a larger number of patients to confirm if current preventive measures are sufficient.