Abstract
PURPOSE: This study set out to define the incidence, predictors, and mortality related
to acute renal failure (ARF) and acute renal failure requiring dialysis (ARFD) after
coronary intervention.
PATIENTS AND METHODS: Derivation-validation set methods were used in 1,826 consecutive
patients undergoing coronary intervention with evaluation of baseline creatinine clearance
(CrCl), diabetic status, contrast exposure, postprocedure creatinine, ARF, ARFD, in-hospital
mortality, and long-term survival (derivation set). Multiple logistic regression was
used to derive the prior probability of ARFD in a second set of 1,869 consecutive
patients (validation set).
RESULTS: The incidence of ARF and ARFD was 144.6/1,000 and 7.7/1,000 cases respectively.
The cutoff dose of contrast below which there was no ARFD was 100 mL. No patient with
a CrCl > 47 mL/min developed ARFD. These thresholds were confirmed in the validation
set. Multivariate analysis found CrCl [odds ratio (OR) = 0.83, 95% confidence interval
(CI) 0.77 to 0.89, P <0.00001], diabetes (OR = 5.47, 95% CI 1.40 to 21.32, P = 0.01), and contrast dose (OR = 1.008, 95% CI 1.002 to 1.013, P = 0.01) to be independent predictors of ARFD. Patients in the validation set who
underwent dialysis had a predicted prior probability of ARFD of between 0.07 and 0.73.
The in-hospital mortality for those who developed ARFD was 35.7% and the 2-year survival
was 18.8%.
CONCLUSION: The occurrence of ARFD after coronary intervention is rare (<1%) but is
associated with high in-hospital mortality and poor long-term survival. Individual
patient risk can be estimated from calculated CrCl, diabetic status, and expected
contrast dose prior to a proposed coronary intervention.
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Article Info
Publication History
Accepted:
April 14,
1997
Received:
December 4,
1996
Identification
Copyright
© 1997 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
