Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions

Eugenia Nikolsky, Roxana Mehran, Zoran Lasic, Gary S. Mintz, Alexandra J. Lansky, Yingbo Na, Stuart Pocock, Manuela Negoita, Issam Moussa, Gregg W. Stone, Jeffrey W. Moses, Martin B. Leon, George Dangas

Research output: Contribution to journalArticlepeer-review

172 Scopus citations

Abstract

Background. The relationship between low hematocrit and contrast-induced nephropathy has not been investigated. Methods. Of 6,773 consecutive patients treated with percutaneous coronary intervention, contrast-induced nephropathy (an increase of ≥25% or ≥0.5 mg/dL in preprocedure serum creatinine, at 48 hours postprocedure) occurred in 942 (13.9%) patients. Results. Rates of contrast-induced nephropathy steadily increased as baseline hematocrit quintile decreased (from 10.3% in the highest quintile to 23.3% in the lowest quintile) (χ2 for trend, P < 0.0001). Stratification by baseline estimated glomerular filtration rate (eGFR) and baseline hematocrit showed that the rates of contrast-induced nephropathy were the highest (28.8%) in patients who had the lowest level for both baseline eGFR and hematocrit. Patients with the lowest eGFR but relatively high baseline hematocrit values had remarkably lower rates of contrast-induced nephropathy (15.8%, 12.3%, 17.1%, and 15.4% in 2nd, 3rd, 4th, and 5th quintiles of baseline hematocrit, respectively) (P < 0.0001). The rates of contrast-induced nephropathy increased with increment in change in hematocrit. Patients in the lowest quintile of baseline hematocrit with absolute hematocrit drop >5.9% had almost doubled rates of contrast-induced nephropathy compared with patients with hematocrit change <3.4% (38.1% vs. 18.8%, respectively) (P < 0.0001). By multivariate analysis, lower baseline hematocrit was an independent predictor of contrast-induced nephropathy; each 3% decrease in baseline hematocrit resulted in a significant increase in the odds of contrast-induced nephropathy in patients with and without chronic kidney disease (11% and 23%, respectively). When introduced into the multivariate model instead of baseline hematocrit, change in hematocrit also showed a significant association with contrast-induced nephropathy. Conclusion. Lower hematocrit is an important risk factor for contrast-induced nephropathy. Whether correcting the hematocrit prepercutaneous coronary intervention might decrease the rates of contrast-induced nephropathy should be addressed in a prospectively designed trial.

Original languageEnglish
Pages (from-to)706-713
Number of pages8
JournalKidney International
Volume67
Issue number2
DOIs
StatePublished - Feb 2005

Keywords

  • Anemia
  • Angioplasty
  • Contrast
  • Hematocrit
  • Nephropathy

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