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Women Have Greater Risk Of Kidney Injury Resulting From Angiography

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Women are 60 percent more likely than men to experience kidney damage from the dye used in x-ray angiograms to diagnose coronary artery disease a new study shows.

Kidney Injury Resulting From AngiographyThe study, presented this week by Dr. Javier Neyra at the National Kidney Foundation's Spring Clinical Meeting in Las Vegas, showed that 20 percent of women who undergo angiograms using a radiocontrast iodine dye develop nephropathy 24 to 72 hours later compared to 14 percent of men.

Neyra told The Hub that while it has been known that women have a higher incidence of radiocontrast induced kidney damage, it has been attributed to a number of factors.  Women tend to be older than men when they undergo coronary angiograms so there has been suspicion that maybe estrogen levels, or age and associated comorbidities might explain the higher risk.

"What we found was that when you corrected for all these other confounding factors, the women still had higher risk of kidney damage from this procedure," Neyra said in a phone interview. "So what we were left with was that being female in and of itself is a risk marker."

Exactly why that should be the case, Neyra says is not known, but he suggests that because men and women patients receive the same amount of dye during a coronary angiograms, it's possible the amount is just too much for a woman's body to handle given her smaller size.

Contrast dyes are used in x-ray angiography to enhance the images taken to show blood flow through arteries near the heart. Neyra, who is an Internal Medicine resident at the Henry Ford Hospital in Detroit, said this is believed to be the first study to look at whether gender plays a role in patients developing radiocontrast-induced nephropathy after coronary angiogram.

While further study is needed, Neyra theorizes that the contrast dye may cause the kidney's blood vessels to constrict, limiting blood flow to the kidneys, which can damage the cells. Also, direct contrast dye toxicity and the production of reactive oxygen species are involved in the pathogenesis.

The study involved examining the records of 1,211 people who had recently undergone coronary angiography from January 2008 through December 2009. The patients were categorized into two groups according to renal function. A total of 481 (39.7 percent) had borderline impaired renal function with an estimated Glomerular Filtration rate (eGFR) of between 15 and 59 mL/min/1.73m2. The second group of 730 patients (60.3 percent) had healthy renal function with an eGFR of at least 60 mL/min/1.73m2 or more.

Among the 530 female patients (43.8%) included in the study 242 were in the low renal function group and 288 were in the normal renal function group.

Radiocontrast induced nephropathy occurred in 105 women (19.8 percent) and in 93 men (13.6 percent). When they did the multivariable analysis, They found being female, the periprocedural use of furosemide, the preventive use of sodium bicarbonate and a contrast volume of more than 100 mL were all linked to higher risk of nephropathy. The results were adjusted for known risk factors such as heart disease, anemia, diabetes and hypotension.

Surprisingly the women with healthy kidneys before the procedure were more likely to develop kidney injury. Neyra said, he thought this was a result of a heightened awareness of the risk of kidney injury in patients with poor kidney function, whereas doctors might not have been as cautious in patients with normal kidney function. Not surprisingly, the study also found that patients had higher risk of nephropathy when they received relatively larger amounts of dye.

"It is known that coronary angiography could be a life-saving procedure," Neyra says. "On the other hand, it has been identified that patients that develop radiocontrast-induced nephropathy have higher mortality rates despite the deterioration in kidney function. The essential aspect is the recognition of high-risk patients in an effort to be more aggressive in IV hydration and surveillance. Both women and doctors need to understand the risks of coronary artery imaging procedures that use dyes, and, take into account other risk factors she may have and consider wither the procedure benefits outweigh the risks."

Dr. Lynda Szczech, president of the National Kidney Foundation said the study shows that more caution is warranted when using these dyes in women.

"These findings suggest that clinicians should proceed carefully when using this procedure in female patients, particularly those with other risk factors," Szczech said.

The American Heart Association estimates that more than 3 million coronary angiograms were performed in 2010. Radiocontrast-induced nephropathy is the third leading cause of hospital-acquired acute kidney injury behind surgery and infection in the United States and can be fatal for some and often results in poor outcomes for survivors.

By Michael O'Leary, contributing writer, Health Imaging Hub

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