Contrast nephropathy post cardiac resynchronization therapy: An under-recognized complication with important morbidity

Objectives: The aim of the study was to define the incidence of contrast nephropathy in patients undergoing cardiac resynchronization therapy (CRT). Background: CRT is a promising new treatment for advanced heart failure. It is a technically demanding procedure with a recognized failure/complication rate. Contrast nephropathy is a well-recognized complication of coronary angiography/intervention, but has not been described following CRT. Methods: We performed a retrospective chart review of patients who had undergone CRT at Mount Sinai Hospital, a tertiary referral center for heart failure management, to define the incidence of contrast nephropathy in patients undergoing CRT. Contrast nephropathy was defined as the occurrence of a 25% or greater increase in serum creatinine within 48 h after contrast administration. Results: Sixty-eight patients underwent a total of seventy-three procedures between October 1st 2000 and December 31st 2003. Ten patients (14%) developed contrast nephropathy. Three of these patients (4%) required hemofiltration and one died. Patients with creatinine >= 200 mu mol/l (2.26mg/dl) were more likely to develop contrast nephropathy than those with creatinine < 200 mu mol/l (6/14 patients [43%] v 4/59 patients [7%], p < 0.01). The mean length of hospital stay post-procedure in patients developing contrast nephropathy was 19 +/- 18 (SD) days versus 4 +/- 5 days for those patients with stable renal function (p < 0.01). Conclusions: Contrast nephropattly is a frequent, but under-recognized complication of CRT with important morbidity/mortality. The extended hospital stay associated with contrast nephropathy has important clinical and health care implications. Patients and physicians need to be aware of this potential risk. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.