Contrast-associated acute kidney injury in patients with diabetes mellitus following elective percutaneous coronary intervention: Insights from an iodixanol-acute kidney injury registry study

Background: Patients with diabetes mellitus (DM) are particularly susceptible to contrast-associated acute kidney injury (CA-AKI). However, few studies have evaluated CA-AKI stages in patients with DM following elective percutaneous coronary intervention (PCI) with iodixanol.

Methods: Patients with DM who underwent elective PCI in 8 Chinese hospitals from May 2020 to November 2021 were prospectively enrolled in the Iodixanol-Acute Kidney Injury Registry (No. ChiCTR1800016719). According to the European Society of Urogenital Radiation on their CA-AKI diagnosis, and follow-up of major adverse renal and cardiovascular events (MARCE), CA-AKI and prognosis predictors were identified using logistic and Cox multivariable regression, respectively.

Results: There were 1120 patients with DM included and the incidence of CA-AKI was 5.8 % (65/1120). However, most CA-AKI patients were at acute kidney injury stage 1 (96.9 %, 63/65). The dose of iodixanol was not an independent risk factor for CA-AKI, however, a hemoglobin level < 110 g/L, a left ventricular ejection fraction (LVEF) <40 %, an estimated glomerular filtration rate < 60 mL/min/1.73m², an N-terminal pro-B-type natriuretic peptide level ≥ 300 pg/mL, and the use of loop diuretics were independent risk factors. Only 3.5 % (39/1120) of patients experienced MARCE. Hypertension, LVEF <40 %, hemoglobin level < 110 g/L, and age > 75 years old were independent risk factors for MARCE, while in comparison to indobufen, aspirin is an independent protective factor against MARCE in diabetic patients.

Conclusions: The incidence of CA-AKI in patients with DM who underwent PCI was low, mostly associated with mild renal impairment, and therefore did not increase the risk of MARCE.