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  Vol. 150 No. 6, June 1990 TABLE OF CONTENTS
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Incidence, Risk Factors, and Clinical Course of Acute Renal Insufficiency After Cardiac Catheterization in Patients 70 Years of Age or Older

A Prospective Study

Michael W. Rich, MD; Charles A. Crecelius, MD, PhD

Arch Intern Med. 1990;150(6):1237-1242.


Abstract



• To evaluate the incidence, risk factors, and clinical course of radiocontrast nephrotoxic effects in the elderly, 183 patients aged 70 years or more undergoing 199 cardiac catheterizations were studied prospectively. Contrast nephropathy (a rise in creatinine level of 44 µmol/L above baseline) occurred in 21 cases (11%). In 16 (76%) of these 21 cases, renal function returned toward baseline within several days. One patient developed transient oliguria, but no deaths were attributable to renal failure. Independent risk factors for renal dysfunction included contrast volume greater than 200 mL, serum albumin level less than 35 g/L, diabetes mellitus, serum sodium level less than 135 mmol/L, and baseline creatinine level greater than 133 µmol/L. Renal insufficiency occurred in 1.2% of patients with no risk factors, 11.2% of those with one risk factor, and more than 20% of those with two or more risk factors. Thus, the incidence and clinical course of radiocontrast nephropathy in the elderly are similar to those in younger patients. High-risk elderly patients who may benefit from more aggressive prophylaxis can be prospectively identified, but the threat of contrast nephrotoxic effects should not be considered a major contraindication to angiography in appropriately selected patients.

(Arch Intern Med. 1990;150:1237-1242)



Author Affiliations



From the Geriatric Cardiology Section (Dr Rich) and the Program on Aging (Dr Crecelius), Jewish Hospital at Washington University Medical Center, St Louis, Mo.


Footnotes



Accepted for publication December 27,1989.

Reprint requests to Geriatric Cardiology, Jewish Hospital, 2106 South Kingshighway, St Louis, MO 63110 (Dr Rich).



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