Evaluation of possible risk factors for the development of acute kidney injury in chronic kidney disease patients undergoing angiography with intraarterial contrast material

ABSTRACT Objective: The aim of this study is to evaluate the potential risk factors for contrast- induced acute kidney injury (CI-AKI) and the effects of contrast media on kidney function in patients with chronic kidney disease (CKD) following intra-arterial contrast administration. Despite advancements in imaging and interventional techniques, the risk of CI-AKI remains for patients at risk of complications. Since there are no effective treatment options for CI-AKI, eliminating risk factors and addressing preventable causes is crucial. The study aims to thoroughly investigate risk factors such as advanced age, comorbidities, use of nephrotoxic drugs, proteinuria, pre-procedural hypotension, low systolic ejection fraction (hemodynamic instability), anemia, hypoalbuminemia, and hyperuricemia in the development of CI- AKI. Methods: This retrospective cross-sectional study included patients with CKD who underwent coronary angiography with intra-arterial contrast administration at Akdeniz University Hospital between January 1, 2020, and December 31, 2023. A total of 300 patients were included. The demographic data, history of chronic diseases and medication use, and laboratory data before and 48 hours after the coronary angiography were recorded. Additionally, the length of hospital stay and whether the patients who developed CI-AKI required hemodialysis were documented. Results: In the study, the incidence of CI-AKI among CKD patients was 25.3%, and 9% of the participants required dialysis within 6 months. Hemodynamic instability, heart failure, low systolic ejection fraction, hyperuricemia, hyperglycemia, elevated HbA1c levels, CKD stage, albuminuria, and proteinuria were found to be associated with an increased risk of CI-AKI. Low levels of hemoglobin, albumin, total protein, and whole blood viscosity (TKV) were also identified as risk factors for impaired kidney function and the development of CI-AKI. Another parameter identified in our study was the development of hyponatremia in patients with CI-AKI. Conclusion: Due to their susceptibility to atherosclerotic diseases, CKD patients frequently require coronary angiography with intra-arterial contrast administration for percutaneous coronary intervention (PCI). CI-AKI is a common condition, 12 particularly in high-risk patient groups, and can increase mortality and morbidity. Therefore, identifying CI-AKI risk factors, monitoring patients appropriately, and taking prophylactic measures are crucial.