From Coronary Contrast to Renal Injury: The Emerging Role of Endothelial Dysfunction

Introduction Contrast-induced acute kidney injury (CIAKI) is a common and serious complication of coronary angiography, caused by iodinated contrast agents. It significantly worsens cardiovascular prognosis and increases in-hospital morbidity and mortality. Objective This study aimed to uncover predictive factors of CIAKI and to investigate the contribution of pre-existing endothelial dysfunction to its onset following percutaneous coronary interventions (PCI). Preventive strategies with potential clinical relevance were concurrently evaluated. Method This was a prospective observational longitudinal study in which we enrolled 187 patients with an indication for coronary angiography. Patients underwent an assessment of renal function: (basal creatinine, 24 h, 48–72 h and 1month after administration of contrast medium), we focused then on the evaluation of endothelial quality index (EQI) by finger thermal monitoring with E4 diagnosis Polymath ( Fig. 1 ). Results 187 patients (134 males), mean age 61.1 ± 11.8 years, were enrolled; 56.7% were type 2 diabetics. CIAKI occurred in 60 patients (33.7%). Mean EQI was 0.86 ± 0.61. A vast majority (95.2%) had endothelial dysfunction (EQI < 2), and 75.9% had severe dysfunction (EQI < 1). CIAKI was significantly associated with severe endothelial dysfunction ( P = 0.007), rescue PCI ( P = 0.002), contrast volume > 100 ml ( P = 0.015), and two-vessel coronary artery disease ( P = 0.008). Multivariate analysis confirmed severe endothelial dysfunction, rescue PCI, and contrast volume ≥ 140 ml as independent risk factors. CIAKI was significantly less frequent in patients receiving pre-/post-hydration with isotonic saline or those under baseline statin therapy ( P = 0.007 and P = 0.008, respectively). Conclusion This study demonstrates a significant association between severe endothelial dysfunction assessed non-invasively by FTM and the risk of CIAKI. These findings highlight the potential of EQI as a novel, low-cost, reproducible predictor of CIAKI, with promising implications for cardiovascular risk stratification and prevention in interventional cardiology.