Contrast induced nephropathy in diabetic and non diabetic patients after coronary intervention

الملخص EN

Background : A rise in contrast enhanced diagnostic imaging and interventional procedures has been observed especially in diabetic patients which was Accompanied by the increased risk of contrast induced nephropathy which negatively impacts the prognosis of those patients.

Contrast induced nephropathy is an important cause of acute renal failure and this form of nephropathy has become the third leading cause of hospital-acquired acute renal failure.

In patients with type 2 diabetes mellitus complications develop 3 times more often, than in patients without diabetes.

In high risk groups elderly patients with type 2 diabetes mellitus and previous history of nephritic pathology, anemia and heart failure, the probability of contrast induced nephropathy remains considerable, despite use of low toxic contrast agents and sufficient hydration.

Objective : The present study aimed to compare the effect of contrast media on renal function of Iraqi patients after therapeutic coronary intervention for patients without type 2 diabetes mellitus and patients with type 2 diabetes mellitus Materials and Methods : Forty two patients participated in the study.

They were divided into two groups as follow : Group A : twenty two patients (12 males and 10 females) without type 2 diabetes mellitus.

Group B : twenty patients (12 males and 8 females) with type 2 diabetes mellitus.

The type 2 diabetic patients classified into four groups according to the drug (s) that used for treatment of diabetes : -13 % of them were treated by insulin.

-25 % were treated by dietary regimen and sulfonyl urea.

-14 % were treated by metformin.

-The remaining were treated by glinides plus biguanides.

All patients involved in the study were given low osmolar non-ionic contrast media Omnipaque (Iohexol).

The study lasted about three months at Shaheed Al-Mihrab Center for Cardiac Catheterization under supervision of specialist interventional cardiologist.

Clinical and laboratory examinations were measured before the percutaneous coronary intervention.

Renal function tests including serum creatinine and serum urea were measured before and 48 hours after percutaneous coronary intervention.

Contrast induced nephropathy was defined as a rise in serum creatinine of 0.5 mg / dL (29.7 μmol / L) or a 25 % increase from the baseline values, assessed at 48 hours of the percutaneous coronary intervention.

Results : 1.

Contrast media caused more significant increase in serum creatinine level in patients with type 2 diabetes mellitus than in patients without type 2 diabetes mellitus.

Moreover, the incidence of contrast induced nephropathy in diabetic patients developed three times more often than in non-diabetic patients.

2.

Contrast media caused a significant increase in serum urea in patients with type 2 diabetes mellitus, whereas in patients without type 2 diabetes mellitus, serum urea did not significantly changed.

3.

Contrast media caused more significant decrease in glomerular filtration rate in patients with type 2 diabetes mellitus than in patients without type 2 diabetes mellitus.

4.

Contrast media caused a significant decrease in creatinine clearance level in patients with type 2 diabetes mellitus, while in patients without type 2 diabetes mellitus, creatinine clearance did not significantly changed.

Conclusion : The present study demonstrats that diabetic patients are susceptible to higher risk of contrast induced nephropathy than non-diabetic patients.