Korean Circ J.  2011 May;41(5):265-271. 10.4070/kcj.2011.41.5.265.

Determination of Safe Contrast Media Dosage to Estimated Glomerular Filtration Rate Ratios to Avoid Contrast-Induced Nephropathy After Elective Percutaneous Coronary Intervention

• Yoon HJ
• Hur SH

• KMID: 2297934
• DOI: http://doi.org/10.4070/kcj.2011.41.5.265

Abstract

BACKGROUND AND OBJECTIVES
To avoid the risk of developing contrast-induced nephropathy (CIN), it has been suggested that patients be subjected to a minimal necessary dose of contrast medium (CM-dose). However, often it is not easy to determine such a dose. This study assessed the usefulness of the ratio of CM-dose to estimated glomerular filtration rate (eGFR) in predicting the risks of CIN and sought to determine the safe level of CM-dose/eGFR in patients undergoing non-emergent percutaneous coronary intervention (PCI).
SUBJECTS AND METHODS
We enrolled a total of 226 patients and calculated the ratio of CM-dose using grams of iodine (g-I) to eGFR, thus expressing it as g-I/eGFR. Among the CIN patients, those with ne-phropathy requiring dialysis (NRD) were also evaluated.
RESULTS
Overall, there were 16 cases (7.1%) of CIN. On univariate and multivariate regression analysis, g-I/eGFR alone was found to be an independent predictor for CIN (hazard ratio=10.73, p<0.001). In an receiver operating characteristic analysis, fair discrimination for CIN was found at a g-I/eGFR level of 1.42 (C statics=0.867), and at this value, the sensitivity and specificity were 81.3% and 80%, respectively. Of patients (n=51) with g-I/eGFR > or =1.42, 23.6% (13/51) and 7.8% (4/51) developed, while those with g-I/eGFR <1.42 (n=171) had a lower incidences of CIN (1.8%, 2/171, p<0.001) and NRD (0%, 0/171, p<0.001).
CONCLUSION
It can be concluded that a g-I/eGFR <1.42 is a simple, useful indicator for determining the safe CM-dose based on the pre-PCI eGFR values. Furthermore, g-I/eGFR might have a close relationship with the development of NRD as well as CIN.

Keyword

Contrast media; Angiography; Acute kidney injury; Effect of drugs

MeSH Terms

Acute Kidney Injury
Angiography
Contrast Media
Dialysis
Discrimination (Psychology)
Glomerular Filtration Rate
Humans
Incidence
Iodine
Percutaneous Coronary Intervention
ROC Curve
Sensitivity and Specificity
Contrast Media
Iodine

Figure

• 

  Fig. 1 Incidence of CIN according to quartiles of g-I/eGFR. Incidence of CIN is markedly higher in quartiles III and IV compared with quartiles I and II. CIN: contrast-induced nephropathy, g-I/eGFR: ratio of delivered contrast media by grams of iodine and estimated glomerular filtration rate.

• 

  Fig. 2 Receiver operating characteristic curves for the prediction of CIN using a g-I/eGFR ratio. The area under the curve for predicting CIN of g-I/eGFR was 0.867. The best cut-off value for g-I/eGFR was determined to be 1.42 (*). At this value, the sensitivity and specificity for the development of CIN were 81.3% and 80%, respectively. AUC: area under the curve, CIN: contrast-induced nephropathy, g-I/eGFR: ratio of delivered contrast media by grams of iodine and estimated glomerular filtration rate.

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  Fig. 3 Depiction of the incidence for CIN and NRD according to g-I/eGFR. Of patients with g-I/eGFR ≥1.42, there were significantly higher incidences of CIN and NRD compared with patients with g-I/eGFR <1.42 (p<0.001). CIN: contrast-induced nephropathy, NRD: nephropathy requiring dialysis, g-I/eGFR: ratio of delivered contrast media by grams of iodine and estimated glomerular filtration rate.

• 

  Fig. 4 Relationship between the g-I/eGFR ratio and clinical course after exposure to contrast Medium. g-I/eGFR levels (mean±SD) were significantly correlated with clinical courses of renal complication after PCI. g-I/eGFR: ratio of delivered contrast media by grams of iodine and estimated glomerular filtration rate, CIN: contrast-induced nephropathy, PCI: percutaneous coronary intervention.

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