Early small creatinine shift predicts contrast-induced acute kidney injury and persistent renal damage after percutaneous coronary procedures

Purpose: Little is known on the impact of contrast-induced acute kidney injury (CI-AKI) on mid- and long-term renal function after percutaneous coronary procedure. The aim of the study was to investigate the incidence of persistent renal damage (PRD) after CI-AKI in a cohort of patients undergoing coronary angiography and/or intervention. Moreover, we sought to assess the predictive value of small creatinine change at 12–24 h (SCrΔ–24 h) from contrast exposure in predicting CI-AKI and PRD. Methods: Complete clinical and biochemical data of 731 patients were retrospectively analyzed at sequential time intervals at baseline, 12–24 h and 48–72 h from the procedure. Data at 30 ± 10 days and 12–24 months were available in 59% and 49% of the cases respectively. Logistic regression was used to assess variables associated with CI-AKI and PRD. ROC analysis was used to test the diagnostic accuracy of SCrΔ-24 h in predicting CI-AKI and PRD. Results: CI-AKI occurred in 130/731 patients (17.8%). At 30 ± 10 days PRD occurred in 54.8% patients who developed CI-AKI. A SCrΔ–24 h >5% demonstrated independent predictive value (OR = 1.05, CI = 1.04–1.06, p < 0.001) and fair accuracy (AUC = 0.80, CI = 0.77–0.84) for CI-AKI. Conclusion: CI-AKI was associated with PRD in >50% of the cases in this single centre cohort. A small and early SCrΔ–24 h demonstrated high predictive value for CI-AKI and may be used as a useful tool to unmask a group of patients at risk for PRD after percutaneous coronary procedures.