Korean Circ J.  2008 Jun;38(6):301-304. 10.4070/kcj.2008.38.6.301.

The Estimated Glomerular Filtration Rate With Using the Mayo Clinic Quadratic Equation as a New Predictor for Developing Contrast Induced Nephropathy in Patients With Angina Pectoris

• Kim U
• Kim YJ
• Lee WJ
• Lee SH
• Hong GR
• Park JS
• Shin DG
• Shim BS

• KMID: 2225776
• DOI: http://doi.org/10.4070/kcj.2008.38.6.301

Abstract

BACKGROUND AND OBJECTIVES: The Mayo clinic quadratic (MCQ) glomerular filtration rate (GFR) equation accurately estimates the GFR when the presence of kidney disease is unknown. The aim of this study is to evaluate the usefulness of the MCQ GFR equation for predicting contrast-induced nephropathy (CIN) in patients with angina pectoris and who are undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).
SUBJECTS AND METHODS
One hundred seven patients diagnosed with stable or unstable angina and who had normal serum creatinine levels (SCr <1.5 mg/dL) were enrolled. The MCQ GFRs, corresponding to before and 48 hours post CAG and/or PCI were calculated using the SCr as a previously described protocol. CIN was defined as a 25% elevation in the SCr or an absolute increase of 0.5 mg/dL (44 micromole /L).
RESULTS
Overall, CIN occurred in 14 (13.1%) patients. CIN developed in 4 (57.1%) patients who had an estimated MCQ GFR less than 60 mL/min/1.73 m2 and in 10 (10%) patients who had a GFR over 60 mL/min/1.73 m2 (p=0.005). On univariate analysis, CIN was associated with the baseline MCQ GFR (p=0.001), the C-reactive protein (CRP) level (p=0.001), the volume of contrast agent (p=0.005), the left ventricular ejection fraction (p=0.001) and the low density lipoprotein cholesterol level (p=0.030). On multivariate analysis, a baseline MCQ GFR < or =60 mL/min/1.73 m2 [odds ratio (OR)=2.0, p=0.001], the volume of contrast agent > or =250 mL (OR 17.1, p=0.002), a CRP level > or =0.5 mg/dL (OR 4.7, p=0.037) and a left ventricular ejection fraction < or =40% (OR 1.7, p=0.020) were the independent risk factors for CIN.
CONCLUSION
The pre-coronary angiography MCQ GFR is a useful predictor for the development of CIN. Strong preventive strategies are needed to avoid developing CIN in these high-risk patients.

Keyword

Glomerular filtration rate; Contrast media; Coronary angiography

MeSH Terms

Angina Pectoris
Angina, Unstable
Angiography
C-Reactive Protein
Cholesterol
Cholesterol, LDL
Contrast Media
Coronary Angiography
Creatinine
Glomerular Filtration Rate
Humans
Kidney Diseases
Lipoproteins
Multivariate Analysis
Percutaneous Coronary Intervention
Risk Factors
Stroke Volume
C-Reactive Protein
Cholesterol
Cholesterol, LDL
Contrast Media
Creatinine
Lipoproteins

Figure

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  Fig. 1 Differences between the groups for the e-GFR as calculated by using the MCQ equation. The mean e-GFR of Group 1, which corresponded to the patient who developed CIN, was significantly lower after PCI as compared to that of Group 2, which corresponded to patients who did not. e-GFR: estimated glomerular filtration rate, MCQ: Mayo clinic quadratic, CIN: contrast-induced nephropathy, PCl: percutaneous coronary intervention.

• 

  Fig. 2 Development of CIN according to the e-GFR level 60 mL/min/1.73 m2. The e-GFR level ≤60 mL/min/1.73 m2 is associated with a higher rate of developing CIN. CIN: contrast induced nephropathy, e-GFR: estimated glomerular filtration rate, MCQ: Mayo clinic quadratic.

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