Risk factors of contrast-induced nephropathy after digital subtraction angiography in patients with acute ischemic stroke and diabetes

Objective To study the alterations of renal function in patients with acute ischemic stroke and diabetes and to analyze the risk factors of contrast-induced nephropathy (CIN) after digital subtraction angiography (DSA). Methods Eight hundred and seventy-one cerebral infarction patients with diabetes who underwent DSA were selected in the Third Affiliated Hospital of Chongqing Medical University and Nanjing Brain Hospital Affiliated to Nanjing Medical University from August 2012 to August 2016. The patients were divided into diabetic group (n=178) and non-diabetic group (n=693). The alterations of renal function and the incidence rate of CIN were observed between two groups 3 days after DSA. Univariate analysis and multi-factor Logistic regression analysis were used to analyze the independent risk factors of CIN. Results The levels of estimated glomerular filtration rate (eGFR, ml·min-1·1.73 m-2) in diabetic group at 1, 2 and 3 days after DSA(81.94±9.38, 75.36±8.21, 84.43±9.72) were lower than that in non-diabetic group (84.62±10.06, 79.08±9.84, 87.62±10.15, t=3.213, 4.645, 3.772, all P<0.05). The levels of serum creatinine (Scr) and cystatin (CysC) in diabetic group at 1, 2 and 3 days after DSA (Scr: 85.63±9.83, 92.37±10.07, 83.43±9.07; CysC: 1.08±0.12, 1.35±0.14, 0.95±0.10) were higher than that in non-diabetic group (Scr: 81.36±8.98, 87.84±9.85, 80.31±8.64, t=5.548, 5.448, 4.253; CysC: 0.97±0.11, 1.21±0.12, 0.88±0.09; t=11.677, 13.400, 9.043; all P<0.05). The incidence rate of CIN in diabetic group (25.84%(46/178)) was higher than that in non-diabetic group (7.07%(49/693), χ2=51.358, P=0.001). Multi-factor Logistic regression analysis showed allergies, plasma brain natriuretic peptide, heart failure, the original renal insufficiency, NIHSS score, contrast agent dosage, preoperative eGFR, preoperative Scr and preoperative CysC were the independent risk factors of CIN in cerebral infarction patients with diabetes. Conclusions The renal function decreased significantly and the incidence rate of CIN was high in cerebral infarction patients with diabetes after DSA. Allergies, plasma brain natriuretic peptide, heart failure, the original renal insufficiency, contrast agent dosage, preoperative eGFR, preoperative Scr and preoperative CysC were the independent risk factors of CIN in cerebral infarction patients with diabetes. Key words: Stroke; Diabetes; Cerebral angiography; Nephrosis; Risk factors