VOLUME 38 | ISSUE 4 | JULY-AUGUST 2018

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Predictive factors for contrast-induced acute kidney injury in high-risk patients given N-acetylcysteine prophylaxis

Wei-Yoon Poh, Marhanis Salihah Omar, Hwee-Pheng Tan

From the Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia and Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Malaysia

How to cite this article:

Poh WY, Omar M, Tan HP. Predictive factors for contrast-induced acute kidney injury in high-risk patients given N-acetylcysteine prophylaxis. Ann Saudi Med 2018; 38(4): 269-276.

Abstract

BACKGROUND: Contrast–induced acute kidney injury (CI-AKI) is rec.ognized as a common complication of radiographic contrast-enhanced procedures. N-acetylcysteine (NAC) is commonly prescribed, but CI-AKI can still develop despite NAC administration as prophylaxis. 

 

OBJECTIVE: Identify the predictive factors for development of CI-AKI in patients prescribed NAC. 

 

DESIGN: Prospective, cross-sectional.

 

SETTING: A tertiary hospital in Malaysia. 

 

PATIENTS AND METHODS: All adult patients who were prescribed NAC for prevention of CI-AKI were identified through an NAC drug us.age monitoring card maintained by the inpatient pharmacy.  The study was conducted from March to July 2017. 

 

MAIN OUTCOME MEASURES: Statistically significant predictive fac.tors for development of CI-AKI despite NAC administration. 

 

SAMPLE SIZE: 152 

 

RESULTS: The most commonly recognized risk factors for CI-AKI present in the study population were renal impairment (n=131, 86.2%), anemia (n=107, 70.4%), and diabetes mellitus (n=90, 59.2%). Hydration therapy was initiated in 128 patients (84.2%) prior to the contrast-enhanced procedure. Sixty-one (40.1%) were treated with nephrotoxic medications concomitantly with NAC. Fifteen (9.9%) patients developed AKI. Hypotension (OR: 6.02; 95% CI 1.25-28.97) and use of high contrast volume (OR: 6.56; 95% CI: 1.41-30.64) significantly increased the odds for AKI. Prior hydration therapy (OR: 0.13; 95% CI 0.03-0.59) showed protective effects. 

 

CONCLUSION: The risk predictors identified for CI-AKI were hypotension, high contrast volume and prior hydration therapy. 

 

LIMITATION: May not have identified other confounding factors for development of CI-AKI.

 

CONFLICT OF INTEREST: None.

 

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