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Glucose level in nondiabetics helps predict kidney injury during angiography

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In nondiabetics, high glucose levels signal an increased risk for contrast-induced acute kidney injury during coronary angiography, new research suggests.

“Although diabetes is a known risk factor for contrast-induced acute kidney in patients undergoing coronary angiography, whether elevated preprocedural glucose levels (regardless of pre-existing diabetes) are associated with higher risk…is unknown,” lead author Dr. Joshua M. Stolker and his coauthors note in the Journal of the American College of Cardiology for April 6.

Dr. Stolker, from the University of Missouri in Kansas City, and colleagues analyzed the occurrence of contrast-induced acute kidney injury in 6358 patients who had angiography for acute myocardial infarction.

When they stratified patients by pre-procedure glucose levels, they found that as levels rose in patients without diabetes, so did rates of contrast injury. For example, the rate rose from 8.2% with glucose <110 mg/dL to 24.3% with glucose of 200 mg/dL or higher (p < 0.001).

In diabetics, however, contrast injury rates did not vary significantly by glucose level.

After adjusting for baseline glomerular filtration rate and other possible confounders, glucose levels of 110 mg/dL or higher increased the risk of contrast injury by at least 31% in patients without diabetes. Once again, in those with diabetes, glucose level was not associated with contrast injury risk.

“The results of this study are important not only because they identify a new risk marker…in patients without diabetes with acute myocardial infarction but because they raise the question of whether interventions such as intensive insulin therapy might reduce risk in this population,” the authors conclude.

J Am Coll Cardiol 2010;55:1433-1440.