PCI complications: renal failure
Editors-In-Chief: Alexandra Almonacid M.D. and Jeffrey J.Popma M.D.
Incidence
- The morbidity and mortality associated with PCI relates directly to the extent of baseline renal disease.
- Patients with evidence of mild renal dysfunction have a 20 percent higher risk of death a one year following PCI than patients with preserved renal function (1-4).
- Mild renal dysfunction following PCI may increase the risk of death up to four fold at one year following PCI compared with patients with preserved renal function (1, 2, 4, 5).
- Worsening of renal function may occur after contrast agent administration in 13 to 20% of patients
- 5% patient will have a 1 mg/dl increase of creatinine following angiography
- <1% chronic dialysis
Etiology
Renal dysfunction following contrast administration during angiography may relate to either contrast induced nephropathy (CIN), cholesterol embolization syndrome, or both.
- Contrast Induced Nephropathy
- The risk of CIN is dependent on the dose of the contrast agents used, hydration status at the time of the procedure, pre-existing renal function of the patient, age, hemodynamic stability, anemia, and diabetes (1, 6), and the risk for cholesterol embolization syndrome relates to catheter manipulation in an ascending or descending atherosclerotic aorta that releases cholesterol crystals (7).
- While the risk of hemodialysis is less than 3 percent in cases of uncomplicated CIN, the in-hospital mortality in the setting of hemodialysis exceeds 30 percent (5).
Risk Factors
- Prior renal insufficiency
- Diabetes Mellitus
- Dehydration before the procedure
- Congestive Heart Failure
- Larger volumes of contrast material
- Nephrotoxic drugs
- Recent (<48 hour) contrast exposure.
Toxicities Associated with Radiocontrast Agents
- Allergic (anaphylactoid) reactions
- Grade I: Single episode of emesis, nausea, sneezing, or vertigo
- Grade II: Hives, multiple episodes of emesis, fevers, or chills
- Grade III: Clinical shock, bronchospasm, laryngospasm or edema, loss of consciousness, hypotension, hypertension, cardiac arrhythmia, angioedema, or pulmonary edema
- Cardiovascular toxicity
- Electrophysiologic
- Bradycardia (asystole, heart block)
- Tachycardia (sinus, ventricular)
- Ventricular fibrillation
- Hemodynamic
- Hypotension (cardiac depression, vasodilation)
- Heart failure (cardiac depression, increased intravascular volume)
- Electrophysiologic
- Nephrotoxicity
- Discomfort
- Nausea
- Vomiting
- Heat and flushing
- Hyperthyroidism
2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1]
PCI in Chronic Kidney Disease (DO NOT EDIT)[1]
| Class I |
| "1. In patients undergoing PCI, the glomerular filtration rate should be estimated and the dosage of renally cleared medications should be adjusted.[2][3][4](Level of Evidence: B)" |
References
- ↑ 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter
|month=ignored (help) - ↑ Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F (2006). "Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate". Annals of Internal Medicine. 145 (4): 247–54. PMID 16908915. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Stevens LA, Nolin TD, Richardson MM, Feldman HI, Lewis JB, Rodby R, Townsend R, Okparavero A, Zhang YL, Schmid CH, Levey AS (2009). "Comparison of drug dosing recommendations based on measured GFR and kidney function estimating equations". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 54 (1): 33–42. doi:10.1053/j.ajkd.2009.03.008. PMC 2756662. PMID 19446939. Retrieved 2011-12-15. Unknown parameter
|month=ignored (help) - ↑ Hassan Y, Al-Ramahi RJ, Aziz NA, Ghazali R (2009). "Impact of a renal drug dosing service on dose adjustment in hospitalized patients with chronic kidney disease". The Annals of Pharmacotherapy. 43 (10): 1598–605. doi:10.1345/aph.1M187. PMID 19776297. Retrieved 2011-12-15. Unknown parameter
|month=ignored (help)
- ref1 PMID 16489569
- ref2 PMID 15957128
- ref3 PMID 12943868
- ref4 PMID 15864241
- ref5 PMID 12010907
- ref6 PMID 15619387
- ref7 PMID 12875753