Contrast-induced acute kidney injury following coronary angiography in patients with end-stage liver disease

Figures & data

Table 1. Baseline characteristics of the ESLD cohorts.

	Non-CIAKI group (n = 138)	CIAKI group (n = 41)
Age (years)	60.3 ± 9.0	59.1 ± 10.1
Female gender	42 (30.4%)	11 (26.8%)
Caucasian race	92 (66.7%)	26 (63.4%)
Body mass index (kg/m^2)	30.3 ± 6.8	30.0 ± 6.5
Chronic conditions
Hypertension	110 (79.7%)	30 (73.2%)
Diabetes mellitus	67 (48.6%)	18 (43.9%)
Hemoglobin A1c (%)	7.6 ± 2.0	7.5 ± 1.9
Chronic kidney disease	45 (32.6%)	11 (28.2%)
CHF (NYHA class III or IV)	37 (26.8%)	17 (41.5%)
Smoking history	75 (54.3%)	25 (61.0%)
Pre-angiography systolic BP (mm Hg)	129.6 ± 30.5	131.0 ± 34.1
Pre-angiography diastolic BP (mm Hg)	67.6 ± 13.5	69.2 ± 15.7
Pre-angiography laboratory values
Blood urea nitrogen (mg/dL)	20.6 ± 12.0	21.8 ± 13.7
Serum creatinine (mg/dL)	1.2 ± 0.6	1.2 ± 0.6
Baseline eGFR (mL/min/1.73 m^2)	70.3 ± 24.9	77.8 ± 31.4
International normalized ratio	1.3 ± 0.9	1.4 ± 0.5
Bilirubin (mg/dL)	1.2 ± 1.2	2.2 ± 4.6
Hematocrit (%)	35.4 ± 6.1	34.8 ± 6.3
Critical indicators
Intra-aortic balloon pump	2 (1.4%)	6 (14.6%)
Intensive care unit admission	22 (15.9%)	18 (43.9%)
Inotropes	3 (2.2%)	6 (14.6%)
Mechanical ventilation	3 (2.2%)	5 (12.2%)
Indications for coronary angiography
Acute coronary syndrome	55 (39.9%)	19 (46.3%)
Chronic stable angina	46 (33.3%)	9 (22.0%)
New-onset CHF	18 (13.0%)	6 (14.6%)
Pre-operative evaluation	19 (13.8%)	7 (17.1%)
Contrast medium
Contrast volume	114.0 ± 86.5	119.6 ± 125.4
Contrast ratio	0.34 ± 0.38	0.32 ± 0.36
Contrast-to-eGFR ratio	1.9 ± 1.6	2.0 ± 2.2
Risk scores
Mehran risk score	6.2 ± 4.2	8.2 ± 6.1
MELD score	9.6 ± 5.7	11.6 ± 7.7
Periprocedural drugs
Beta-blocker	90 (65.2%)	20 (48.8%)
Diuretic	65 (47.1%)	23 (56.1%)
ACEI/ARB	60 (43.5%)	12 (30.0%)
NSAID	74 (53.6%)	17 (41.5%)
Prophylactic intravenous fluids	52 (37.7%)	12 (29.3%)

Categorical data are reported as frequencies (percentage of group). Numerical data are reported as mean ± standard deviation. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BP, blood pressure; CIAKI, contrast-induced acute kidney injury; CHF, congestive heart failure; eGFR, estimated glomerular filtration rate; ESLD, end-stage liver disease; MELD, Model for End-Stage Liver Disease; NSAID, non-steroidal anti-inflammatory drug; NYHA, New York Heart Association.

Figure 1. All-cause mortality at 1 year and at the end of follow-up based on contrast-induced acute kidney injury (CIAKI) status and beta-blocker use. Stippled pattern, CIAKI; downward diagonal pattern, non-CIAKI; solid black, beta-blocker; solid white, non-beta-blocker.

Figure 2. Creatinine trends before and after coronary angiography based on contrast-induced acute kidney injury (CIAKI) status. Bars indicate mean and standard deviation for each parameter. Solid black, baseline serum creatinine (SCr); solid white, peak SCr within 72 hours; stippled pattern, peak SCr within 1 year.

Table 2. Independent predictors of CIAKI and all-cause mortality for the duration of follow-up.

Parameter	P-value	Odds Ratio	CI
Independent Predictors of CIAKI
ICU admission	0.039	2.72	1.05–7.01
Baseline eGFR (per mL/min/1.73 m^2)	0.031	1.02	1.002–1.035
Independent Predictors of All-Cause Mortality
Beta-blocker use	0.039	2.13	1.04–4.38
INR (per 0.1 unit)	0.021	1.37	1.05–1.78
Mehran risk score (per point)	0.016	1.13	1.02–1.25

CIAKI, contrast-induced acute kidney injury; eGFR, estimated glomerular filtration rate; ICU, intensive care unit; INR, international normalized ratio.