Relationship between pre-procedural microalbuminuria and renal functional changes after coronary computed tomography in diabetic patients. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Isobe, Satoshi; Yamada, Takashi; Yuba, Miyuki; Hayashi, Mutsuharu; Ishii, Hideki; Murohara, Toyoaki
• Is Part Of: Journal of cardiology. Volume 69:Issue 4(2017:Apr.)
• Page Start: 666
• Page End: 670
• Publication Date: 2017-04
• Subjects: Diabetes mellitus -- Cystatin C -- Renal function -- Urinary microalbumin -- Coronary computed tomography angiography; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2016.06.005
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: Diabetes is one of the risks for development of contrast-induced nephropathy (CIN). The percentage change in cystatin C (CyC), a recent new reliable marker for detecting subtle renal dysfunction, of ≥10% for 24 h after procedure is an independent predictor for developing CIN. Urinary microalbumin is one of the markers for preclinical nephropathy in diabetic patients. We investigated the relationship between pre-procedural urinary microalbumin and renal functional changes using CyC after coronary computed tomography angiography (CCTA) in diabetic patients. Methods: Two hundred and six patients with diabetes scheduled for CCTA were enrolled. The serum creatinine and CyC levels were measured before and 24 h after CCTA. The percentage change in CyC (%CyC) and absolute change in estimated glomerular filtration rate (eGFR) from pre- to post-procedure were calculated. The pre-procedural urinary microalbumin was measured. The patients were classified into 2 groups as follows: group A comprised 93 patients with pre-procedural urinary microalbumin of ≥30 mg/g creatinine; and group B comprised 113 patients with one of <30 mg/g creatinine. Results: The %CyC, fasting plasma glucose levels, and HbA1c were significantly greater in group A than in group B. The absolute change in eGFR was significantly less in group A than in group B. A significant correlation was seen between urinary microalbumin and %CyC ( r = 0.49, p < 0.0001). Multivariate regression analysis revealed that pre-procedural urinary microalbumin and HbA1c were independent predictors for a %CyC ≥ 10% (OR: 1.030, 95% CI: 1.020–1.039, p = 0.008; and OR: 1.011, 95% CI: 1.007–1.016, p = 0.004, respectively). The optimal cut-off value of a pre-procedural urinary microalbumin level was 64 mg/g creatinine for predicting a %CyC ≥ 10% using receiver-operating characteristic curve analysis with a sensitivity, specificity, and area under the curve of 56%, 88%, and 0.72, respectively. Conclusions: Renal functional changes should be paid attention to after CCTA, particularly in diabetic patients exhibiting elevated pre-procedural urinary microalbumin even though they indicate preserved eGFR.