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Contrast induced acute kidney injury is an iatrogenic renal injury that follows intravascular administration of radio-opaque contrast media (CM) in susceptible individuals. Contrast-induced acute kidney injury is the third most common cause for acute kidney injury (AKI) in hospitalized patients. The machanisms described were vasoconstriction and medullary hypoxia, direct tubular toxicity and generation of reactive oxygen species. We report our experience with contrast induced acute kidney injury in patients undergoing coronary and peripheral angiogram at our centre.
Study Design: Hospital- based single group cohort study (longitudinal prospective study) is to be conducted.
Study setting: Nephrology and Cardiology Departments, Lakeshore Hospital, Kochi Kerala and study subjects were the subjects undergoing coronary and peripheral angiogram during the study period.
Study period: Within 6 Months following IEC ( Institutional Ethical Committee clearance), from September 2022 to February 2023.
INCLUSION CRITERIA
1. Age > 18 years
2. Those with normal renal functions
3. Chronic Kidney Disease stage II, III, IV
EXCLUSION CRITERIA-
1 CKD patients on maintenance hemodialysis
2 Patients coming with hypotension and shock
3 Patients requiring inotropic support
There were 200 patients underwent angiogram (coronary/peripheral) during the study period. Out of 200 patients, 155 (77%) were males and 45 (23%) were females, 42 (21%) patients were in the age group 70 years and above , 66 (33%) patients were in the age group between 60 and 69 years. 58 (29%) patients developed Contrast induced acute kidney injury. Incidence of CIAKI was 34% in type 2 diabetes patients, 76% in chronic kidney disease patients. Incidence of CIAKI was 48% in the age group 70 years and above ,34% in the age group between 60 and 69 years. 12% of the patients who developed CIAKI had normal renal functions , out of which 52% patients achieved normal functions with in 10 days. Contrast media used was nonionic contrast media either iohexol (low osmolar) or iodixanol (isoosmolar). 71(36%) patients were given iodixanol and 129 (64%) patients were given iohexol. High risk patients like age above 70 years, underlying chronic kidney disease were mostly given iodixanol. None of the patients became dialysis dependent and none died.
Incidence of CI-AKI after coronary/peripheral angiogram was 58% in my study. The higher incidence of CIAKI in my study is probably due to the higher number of elderly population, patients with underlying chronic kidney disease and type 2 diabetes mellitus. Cautious hydration, lower amount of contrast media (preferably non ionic low osmolar/iso osmolar) can prevent CIAKI in high risk patients.