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Serum NGAL as a biomarker for subclinical contrast induced nephropathy (CIN) in diabetic patients with renal impairment at 24 hours post coronary catheterization.
Serum NGAL has been shown to be a novel biomarker for acute kidney injury. Studies done previously showed that serum NGAL level peak at 4 hours after the administration of a contrast agent as opposed to serum creatinine. Recently the term ‘subclinical acute kidney injury' plays an important role, as it increases morbidity and mortality. Using serum NGAL as a marker, we aim to uncover the incidence of subclinical CIN on a population of diabetic patients with renal impairment undergoing elective coronary angiogram in Cardiology Unit University Malaya Medical Centre.
To evaluate incidence of subclinical CIN in diabetic patients with renal impairment undergo elective coronary angiogram using new and conventional biomarker.
This is a prospective study of 70 consecutive patients who fulfilled the following inclusion criteria:
1. Elective admission for coronary angiogram.
2. Stage 3 & 4 diabetic CKD with MDRD equation.
3. Not on nephrotoxic drug 48 hours prior to the study.
The blood samples were taken at 0H; 4H and 24H post coronary angiogram and sent for serum creatinine (sCr) and NGAL measurement using Alere Triage® NGAL Test.
Out of the 70 samples taken, 25.7% received intravenous saline infusion and oral N-acetyl-cysteine (NAC) for CIN prophylaxis. Mean age of the patients was 66.8 ± 4.7 years with mean estimated GFR of 45.3 ± 13.6 mls/min/1.73m2. Twelve point eight percents (12.8%) patients were diagnosed as CIN based on increment 25% serum creatinine from the baseline. There was a significant raised of serum NGAL at 4 hours after contrast administration in 77.1% of the patients without raised serum creatinine suggesting subclinical acute kidney injury. The magnitude of NGAL increment was significantly lower in the goups receiving CIN prophylaxis (4.8 ng/ml vs 42.3 ng/ml, p < 0.001), suggestive protective effect of prophylaxis.
Serum NGAL level is a useful acute clinical marker for CIN post coronary angiogram in high-risk patients as the level raised as early as 4H compared to serum creatinine. Our high-risk cohort has 77.1% incidence of subclinical AKI, higher compared to previous study. Patients who received CIN prophylaxis had lesser magnitude of tubular injury compared to those who were not given.
- 2013 American College of Cardiology Foundation