Department of Cardiology, Koc University Hospital, Istanbul, Turkey,
Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey.
Kidney Blood Press Res. 2020;45(1):131-141. doi: 10.1159/000504547. Epub 2019 Dec 20.
Hyperuricemia may cause acute kidney injury by activating inflammatory, pro-oxidative and vasoconstrictive pathways. In addition, radiocontrast causes an acute uricosuria, potentially leading to crystal formation. We therefore aimed to investigate the effect of urine acidity and urine uric acid level on the development of contrast-induced nephropathy (CIN) in patients undergoing elective coronary angiography.
We enrolled 175 patients who underwent elective coronary angiography. CIN was defined as a >25% increase in the serum creatinine levels relative to basal values 48-72 h after contrast use. Prior to coronary angiography and 48-72 h later, serum uric acid, urea, creatinine, bicarbonate levels, and spot uric acid to creatinine ratio (UACR) were measured.
Of the 175 subjects included, 29 (16.6%) developed CIN. Those who developed CIN had a higher prevalence of diabetes, higher UACR (0.60 vs. 0.44, p = 0.014), higher contrast volume, and lower serum sodium level. With univariate analysis of a logistic regression model, the risk of CIN was found to be associated with diabetes (p = 0.0016, OR = 3.8 [95% CI: 1.7-8.7]), urine UACR (p = 0.0027, OR = 9.6 [95% CI: 2.2-42.2]), serum sodium (p = 0.0079, OR = 0.8 [95% CI: 0.77-0.96]), and contrast volume (p = 0.0385, OR = 1.8 [95% CI: 1.03-3.09]). In a multiple logistic regression model with stepwise method of selection, diabetes (p = 0.0120, OR = 3.2 [95% CI: 1.3-8.1]) and UACR (p = 0.0163, OR = 6.9 [95% CI: 1.4-33.4]) were the 2 risk factors finally identified.
We have demonstrated that higher urine UACR is associated with the development of CIN in patients undergoing elective coronary angiography.
高尿酸血症可通过激活炎症、促氧化和血管收缩途径导致急性肾损伤。此外，造影剂会引起急性尿酸尿症，可能导致晶体形成。因此，我们旨在研究尿液酸度和尿酸水平对接受选择性冠状动脉造影的患者发生造影剂肾病（CIN）的影响。
我们纳入了 175 名接受选择性冠状动脉造影的患者。CIN 定义为造影后 48-72 小时血清肌酐水平相对于基础值升高>25%。在冠状动脉造影前和 48-72 小时后，测量血清尿酸、尿素、肌酐、碳酸氢盐水平和尿尿酸/肌酐比值（UACR）。
在 175 名受试者中，29 名（16.6%）发生 CIN。发生 CIN 的患者糖尿病患病率更高，UACR 更高（0.60 比 0.44，p = 0.014），造影剂用量更大，血清钠水平更低。单因素 logistic 回归模型分析发现，CIN 风险与糖尿病相关（p = 0.0016，OR = 3.8 [95%CI：1.7-8.7]）、尿 UACR（p = 0.0027，OR = 9.6 [95%CI：2.2-42.2]）、血清钠（p = 0.0079，OR = 0.8 [95%CI：0.77-0.96]）和造影剂用量（p = 0.0385，OR = 1.8 [95%CI：1.03-3.09]）。逐步法选择的多因素 logistic 回归模型显示，糖尿病（p = 0.0120，OR = 3.2 [95%CI：1.3-8.1]）和 UACR（p = 0.0163，OR = 6.9 [95%CI：1.4-33.4]）是最终确定的 2 个危险因素。
我们的研究表明，在接受选择性冠状动脉造影的患者中，较高的尿 UACR 与 CIN 的发生相关。
