Impact of continuation of metformin prior to elective coronary angiography on acute contrast nephropathy in patients with normal or mildly impaired renal functions

Veysel Oktay, İlknur Calpar Çıralı, Ümit Yaşar Sinan, Ahmet Yıldız, Murat Kazım Ersanlı, Veysel Oktay, İlknur Calpar Çıralı, Ümit Yaşar Sinan, Ahmet Yıldız, Murat Kazım Ersanlı

Abstract

Objective: Discontinuation of metformin treatment in patients scheduled for elective coronary angiography (CAG) is controversial because of post-procedural risks including acute contrast-induced nephropathy (CIN) and lactic acidosis (LA). This study aims to discuss the safety of continuing metformin treatment in patients undergoing elective CAG with normal or mildly impaired renal functions.

Methods: Our study was designed as a single-centered, randomized, and observational study including 268 patients undergoing elective CAG with an estimated glomerular filtration rate of >60 mL/min/1.73 m2. Of these patients, 134 continued metformin treatment during angiography, whereas 134 discontinued it 24 h before the procedure. CIN was defined as either a 25% relative increase in serum creatinine levels from the baseline or a 0.5 mg/dL increase in the absolute value that measured 48 h after CAG. Logistic regression analysis was performed to identify independent predictors of CIN and LA after CAG.

Results: Both groups were comparable in terms of demographics and laboratory values. CIN at 48 h was 8% (11/134) in the metformin continued group and 6% (8/134) in the metformin discontinued group (p=0.265). Patients in neither of the groups developed metformin-induced LA. Based on multiple regression analysis, the ejection fraction [p=0.029, OR: 0.760; 95% CI (0.590-0.970)] and contrast volume [p=0.016, OR: 0.022 95% CI (0.010-0.490)] were independent predictors of CIN.

Conclusion: Patients scheduled for elective CAG with normal or mildly impaired renal functions and preserved left ventricular ejection fraction (>40%) may safely continue metformin treatment.

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Rate of development of contrast-induced acute kidney injury (CI-AKI) in both groups after CAG
Figure 2
Figure 2
Comparison of eGFR changes in the two groups
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5731282/bin/AJC-18-334-g003.jpg
Firuz Kanatlı, Ph.D. (Hon.) 1932-2017 We are deeply sorry about the sad loss of Firuz Kanatlı, Ph.D. (Hon.), who was an unconditional supporter of The Anatolian Journal of Cardiology. He made a great psychological and financial contribution to the achievement of having our journal climb in the international rankings, and was a role model to us. May the mercy of God be bestowed upon him. We send our sincere condolences to all of his friends and family. The Anatolian Journal of Cardiology

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