{"id":1493,"date":"2010-04-07T14:41:27","date_gmt":"2010-04-07T18:41:27","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/elevated-glucose-levels-and-iv-contrast-deliver-a-double-hit%c2%a0to-renal-function\/"},"modified":"2014-12-02T09:31:19","modified_gmt":"2014-12-02T14:31:19","slug":"elevated-glucose-levels-and-iv-contrast-deliver-a-double-hit%c2%a0to-renal-function","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/04\/07\/elevated-glucose-levels-and-iv-contrast-deliver-a-double-hit%c2%a0to-renal-function\/","title":{"rendered":"Elevated Glucose Levels and IV Contrast Deliver a Double Hit\u00a0to Renal Function"},"content":{"rendered":"<p>Hyperglycemia\u00a0before coronary angiography\u00a0raises the risk for contrast-induced, acute kidney injury (CI-AKI). My colleagues and I reached this conclusion in an\u00a0<a href=\"http:\/\/content.onlinejacc.org\/cgi\/reprint\/55\/14\/1433.pdf\">investigation<\/a> of the relationship between pre-procedural glucose levels and CI-AKI in 6,358 patients who underwent coronary angiography during hospitalization for\u00a0MI. We found found a high risk for CI-AKI among those patients who had pre-procedural hyperglycemia but no known diabetes, even when the baseline renal function was normal.<\/p>\n<p>While diabetes is a known risk factor for CI-AKI, it has not been clear until now that the risk extends to hyperglycemic patients without established diabetes. Importantly, elevated glucose levels are present in more than 40% of all patients hospitalized with MI, and more than half of\u00a0these patients\u00a0do not have\u00a0known diabetes.<\/p>\n<p>Some of the pathophysiologic mechanisms by which contrast can cause renal tubular injury (oxidative stress and free radical damage) are also activated in the setting of hyperglycemia. Thus, elevated pre-procedural glucose levels and IV contrast administration\u00a0may deliver a \u201cdouble hit\u201d to kidney function.<\/p>\n<p>While\u00a0patients with elevated glucose levels but no known diabetes are not currently on clinicians&#8217; radar screen as at risk for contrast-mediated nephropathy, their risk for kidney injury is as high as or even higher than those with established diabetes. They should, therefore, receive the same pre-angiography precautions and close post-procedural surveillance of renal function as other high-risk patients (e.g., those with known diabetes and CKD). Our findings raise the possibility that pre-procedural glucose control might reduce the risk for acute kidney injury, but this would need to be proven in a prospective clinical trial. Given the paucity of effective CI-AKI preventative strategies, this possibility merits further investigation.<\/p>\n<p>Based on these results, I believe that all MI patients should have pre-angiography assessment of glucose levels to guide the employment of CI-AKI prophylactic measures and the intensity of post-procedural monitoring of renal function. What are your thoughts?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hyperglycemia\u00a0before coronary angiography\u00a0raises the risk for contrast-induced, acute kidney injury (CI-AKI). My colleagues and I reached this conclusion in an\u00a0investigation of the relationship between pre-procedural glucose levels and CI-AKI in 6,358 patients who underwent coronary angiography during hospitalization for\u00a0MI. We found found a high risk for CI-AKI among those patients who had pre-procedural hyperglycemia but [&hellip;]<\/p>\n","protected":false},"author":622,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[],"class_list":["post-1493","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/622"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=1493"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1493\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=1493"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=1493"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=1493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}