Contrast-Induced Nephropathy after Coronary Procedures: Frequency and Determinants in a Prospective Cohort Study

Abstract

Objectives: To determine the frequency and identify the determinants of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI) in a tertiary care hospital in rural Pakistan. Methodology: This prospective observational cohort study was conducted from May 15, 2025, to November 15, 2025, at Saidu Teaching Hospital, Swat. A total of 196 patients undergoing coronary angiography and/or PCI were enrolled. Baseline demographic, clinical, and procedural data were collected. Serum creatinine levels were measured at baseline, 48 hours, and 72 hours post-procedure. CIN was defined as an increase in serum creatinine ≥0.5 mg/dL or ≥25% from baseline within 48–72 hours. Statistical analysis included univariate tests and multivariable logistic regression using Firth’s penalized likelihood method. Results: The incidence of CIN was 11.2% at 48 hours and increased to 13.8% after 72-hour follow-up. Among CIN patients, 59.3% were diabetic, 18.5% had hypotension, and 44.4% had exposure to nephrotoxic drugs. Univariate analysis showed significant associations of CIN with diabetes, hypotension, nephrotoxic drug use, procedure type, and contrast volume (p < 0.05). Multivariable analysis identified diabetes mellitus (adjusted odds ratio [aOR] = 3.85, 95% CI: 1.41–10.52, p = 0.009) and contrast volume >100 mL (aOR = 4.92, 95% CI: 1.88–12.85, p = 0.001) as independent predictors. Conclusion: CIN is a frequent complication following coronary procedures, particularly among diabetic patients and those exposed to higher contrast volumes. These findings underscore the importance of risk stratification and preventive strategies, including optimized hydration and contrast minimization, especially in resource-limited settings.