Predictors of worsening renal function after computed tomography coronary angiography: Assessed by cystatin C

BACKGROUND: An increase in cystatin C (CyC) of R10% for 24 hours may predict contrastinduced nephropathy and worse outcomes in patients with renal dysfunction undergoing invasive coronary angiography. OBJECTIVE: We investigated the changes in CyC in patients with preserved renal function referred for contrast-enhanced coronary computed tomography angiography (CTA). METHODS: We studied 151 patients undergoing CTA with 70 mL of iopamidol. Serum creatinine and CyC, a sensitive measure of renal dysfunction, shown to be associated with adverse outcomes, were measured 1 day and 1 week after CTA, respectively. The percentage change in CyC (%CyC) was determined and evaluated in comparison to fluid intake. RESULTS: The patients were dichotomized into 2 groups: 47 patients had R10% increase in CyC 1 day after CTA (group A) and 104 did not (group B). The percentage of diabetic patients, hemoglobin A1c (HbA1c), and the CyC levels at 1 week were significantly greater, and the oral fluid volume was significantly lower in group A than in group B. The %CyC inversely correlated with oral fluid volume (r 52 0.80, P , 0.0001) and positively with HbA1c (r 5 0.38, P , 0.001). Multiple regression analysis showed that oral fluid intake (b 52 0.796, P , 0.0001) and HbA1c (b 5 0.128, P 5 0.007) are independent predictors for %CyC of R10%. CONCLUSION: Frequency of CyC elevation was strongly related to hydration after the study and also weakly related to HbA1c. Sufficient oral fluid intake (oral fluid volume/kg R 20 mL/kg) is crucial, particularly for poorly controlled diabetic patients referred for CTA even though they show preserved renal function.