Reference renal artery diameter is a stronger predictor of contrast-induced nephropathy than chronic kidney disease in patients with high cardiovascular risk

Introduction: The incidence of contrast-induced nephropathy (CIN) increases in high cardiovascular risk patients. Chronic kidney disease (CKD) is a known risk factor for CIN development. In a previous report, we demonstrated that the mean reference renal artery diameter (RVD) is an important determinant of CKD in patients undergoing coronary angiography for ischemic heart disease. However, RVD was never tested as a predictor of CIN.

Aim: To look at the predictors of CIN.

Methods: A total of 218 consecutive patients undergoing coronary and renal angiography were enrolled from the cohort of the RAS-CAD study (NCT 01173666). CIN was defined as a relative increase in baseline serum creatinine ≥25% within 1 week of contrast administration.

Results: The incidence of CIN was 22%. In a fully adjusted model, contrast medium dose (20 ml increase, OR 1.12, 95% CI 1.06-1.19, p < 0.001), iso-osmolar contrast media (OR 0.28, 95% CI 0.09-0.99, p < 0.05), atherosclerotic renovascular disease (OR 2.69, 95% CI 1.32-5.48, p < 0.05), and RVD (1 mm/1.73 m(2) increase, OR 0.59, 95% CI 0.41-0.86, p < 0.05) had the greatest effect on outcome and were identified as independent predictors of CIN. CKD was selected as a predictor of CIN only in a model without RVD.

Conclusions: In patients undergoing coronary angiography for ischemic heart disease, RVD is a stronger predictor of CIN than CKD.