Contrast medium volume to creatinine clearance ratio: A predictor of contrast‐induced nephropathy in the first 72 hours following percutaneous coronary intervention

Tan, Ning; Liu, Yong; Zhou, Yingling; He, Pengcheng; Yang, Jing; Luo, Jianfang; Chen, Jiyan

doi:10.1002/ccd.23048

Cited by 43 publications

(55 citation statements)

References 21 publications

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“…Reported CIN frequency (sCR rise ≥44.2 μmol and/or 25% from baseline) at g-I/eGFR ratios <1.0 in the PCI studies were ≤3% [3,13,14,26,27] and mean g-I/GFR ratios in patients without and with CIN ranged between 0.7-1.0 and 1.2-1.8, respectively [13,15,23,27]. Although no such studies based on individual patients exist regarding CM-enhanced CT, pooled analysis of CT studies reporting mean data of g-I dose (or mean volume and concentration) and eGFR demonstrates a weighted mean CIN risk of 6% at a weighted mean g-I/eGFR ratio of 0.9 (Table 1).…”

Section: Contrast Medium Dose/gfr Ratio As a Predictor Of Cinmentioning

confidence: 98%

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Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

et al. 2012

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We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since 1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, 2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, 3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, 4) the rate of CIN following intra-arterial coronary procedures may also be exaggerated owing to other causes of acute kidney failure, such as haemodynamic instability and microembolisation, 5) roughly the same gramiodine/GFR ratio (≈1:1) as a limit of relatively safe CM doses has preliminarily been found for both intravenous CT and intra-arterial coronary procedures and 6) the substantially higher injected intravenous CM dose rate during CT relative to an intra-arterial coronary procedure might actually pose a higher risk of CIN following CT. Key Points• Most intra-arterial injections of contrast media are intravenous relative to the kidneys.• No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial.• Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures. • Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies.

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Section: Contrast Medium Dose/gfr Ratio As a Predictor Of Cinmentioning

confidence: 98%

“…This ratio has during recent years been studied with the goal of defining a threshold value for the risk of CIN in PCI [13][14][15][23][24][25][26][27]. Analysis of these studies demonstrates a weighted mean g-I/eGFR value >1.2 to be a significant and independent predictor of CIN (Table 2).…”

Section: Contrast Medium Dose/gfr Ratio As a Predictor Of Cinmentioning

confidence: 99%

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

et al. 2012

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“…3,4 Several previous studies have investigated the predictive value of the ratio of contrast media volume-to-creatinine clearance (V/CrCl) for CIN after percutaneous coronary intervention (PCI). 5,6 A V/CrCl value >3.7 was found to be a significant independent predictor of an early (within 24 hour) abnormal increase in serum creatinine after PCI in a group of consecutive patients; this became 1 recommended method for evaluating the safe maximum volume of contrast. 5 Studies from our group also indicated that V/CrCl >2.62 was a significant and independent predictor of CIN (within 48-72 hour) in consecutive patients undergoing PCI.…”

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confidence: 96%

Safe Limits of Contrast Vary With Hydration Volume for Prevention of Contrast-Induced Nephropathy After Coronary Angiography Among Patients With a Relatively Low Risk of Contrast-Induced Nephropathy

Liu

Chen

Tan

et al. 2015

Circ: Cardiovascular Interventions

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Background-Few studies have investigated the safe limits of contrast to prevent contrast-induced nephropathy (CIN) based on hydration data. We aimed to investigate the relative safe maximum contrast volume adjusted for hydration volume in a population with a relatively low risk of CIN. Methods and Results-The ratios of contrast volume-to-creatinine clearance (V/CrCl) and hydration volume to body weight (HV/W) were determined in patients undergoing cardiac catheterization. Receiver-operator characteristic curve analysis based on the maximum Youden index was used to identify the optimal cutoff for V/CrCl in all patients and in HV/W subgroups. Eighty-six of 3273 (2.6%) patients with mean CrCl 71.89±27.02 mL/min developed CIN. Receiver-operator characteristic curve analysis indicated that a V/CrCl ratio of 2.44 was a fair discriminator for CIN in all patients (sensitivity, 73.3%; specificity, 70.4%). After adjustment for other confounders, V/CrCl >2.44 continued to be significantly associated with CIN (adjusted odds ratio, 4.12; P<0.001) and the risk of death (adjusted hazard ratio, 2.62; P<0.001). The mean HV/W was 12.18±7.40. We divided the patients into 2 groups (HV/W ≤12 and >12 mL/kg). The best cutoff value for V/CrCl was 1.87 (sensitivity, 67.9%; specificity, 64.4%; adjusted odds ratio, 3.24; P=0.011) in the insufficient hydration subgroup (HV/W, ≤12 mL/kg; CIN, 1.32%) and 2.93 (sensitivity, 69.0%; specificity, 65.0%; adjusted odds ratio, 3.04; P=0.004) in the sufficient hydration subgroup (HV/W, >12 mL/kg; CIN, 5.00%). Conclusions-The V/CrCl ratio adjusted for HV/W may be a more reliable predictor of CIN and even long-term outcomes after cardiac catheterization. We also found a higher best cutoff value for V/CrCl to predict CIN in patients with a relatively sufficient hydration status, which may be beneficial during decision-making about contrast dose limits in relatively low-risk patients with different hydration statuses. (Circ Cardiovasc Interv. 2015;8:e001859.

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“…al) to >6.15 (Barbieri et. al) (14) (15) . These data are not strictly comparable with those reported in the current study because of the differences in the total number of the patients studied, the number of patients with chronic kidney disease, the definition of CIN and the overall incidence of CIN.…”

Section: Cin Has Been a Bane Of Interventional Cardiologymentioning

confidence: 99%

Volume of contrast to creatinine clearance ratio: a novel pharmacokinetic index for prediction of contrast induced nephropathy in stage three chronic kidney disease patients undergoing coronary angioplasty

Valappil¹

2017

JMSCR

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Contrast medium volume to creatinine clearance ratio: A predictor of contrast‐induced nephropathy in the first 72 hours following percutaneous coronary intervention

Abstract: A V/CrCl ratio > 2.62 was a significant and independent predictor of CIN after PCI in unselected patients.

Cited by 43 publications

References 21 publications

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

Safe Limits of Contrast Vary With Hydration Volume for Prevention of Contrast-Induced Nephropathy After Coronary Angiography Among Patients With a Relatively Low Risk of Contrast-Induced Nephropathy

Volume of contrast to creatinine clearance ratio: a novel pharmacokinetic index for prediction of contrast induced nephropathy in stage three chronic kidney disease patients undergoing coronary angioplasty

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