Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention

Abstract

BackgroundLimiting the contrast volume to creatinine clearance (V/CrCl) ratio is crucial for preventing contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, the incidence of CI-AKI and the distribution of V/CrCl ratios may vary according to patient body habitus.ObjectiveWe aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs).MethodsWe evaluated 8782 consecutive patients undergoing PCI and who were registered in a large Japanese database. CI-AKI was defined as an absolute serum creatinine increase of 0.3 mg/dL or a relative increase of 50%. The effect of the V/CrCl ratio relative to CI-AKI incidence was evaluated within the low- (≤25 kg/m2) and high- (>25 kg/m2) BMI groups, with a V/CrCl ratio > 3 considered to be a risk factor for CI-AKI.ResultsA V/CrCl ratio > 3 was predictive of CI-AKI, regardless of BMI (low-BMI group: odds ratio [OR], 1.77 [1.42–2.21]; P < 0.001; high-BMI group: OR, 1.67 [1.22–2.29]; P = 0.001). The relationship between BMI and CI-AKI followed a reverse J-curve relationship, although baseline renal dysfunction (creatinine clearance <60 mL/min, 46.9% vs. 21.5%) and V/CrCl ratio > 3 (37.3% vs. 20.4%) were predominant in the low-BMI group. Indeed, low BMI was a significant predictor of a V/CrCl ratio > 3 (OR per unit decrease in BMI, 1.08 [1.05–1.10]; P < 0.001).ConclusionsA V/CrCl ratio > 3 was strongly associated with the occurrence of CI-AKI. Importantly, we also identified a tendency for physicians to use higher V/CrCl ratios in lean patients. Thus, recognizing this trend may provide a therapeutic target for reducing the incidence of CI-AKI.

Impact of Geriatric Nutritional Index in Contrast-Induced Nephropathy Developed in Patients with Non-ST Segment Elevation Myocardial Infarction who Underwent Percutaneous Coronary Intervention

“…Due to an inverse relation between inflamation and albumin, low albumin levels in CIN patients might be explained by increased inflamation status. The relation between BMI and CIN development has been evaluated in different studies and the results are confounding [1][2][3][4] . Some studies have shown that low BMI, while others have established that a high BMI is a risk factor.…”

“…Contrast-induced nephropathy (CIN) is a commonly observed undesirable condition in patients undergoing percutaneous coronary intervention (PCI). CIN is related with poorer outcomes for patients, including need for renal dialysis and higher mortality [1][2][3] . Previous studies reported that the prevalence of CIN after CAG or PCI procedures range from 2%-15% and can reach up to 50% in patients under high risk such as diabetes mellitus (DM) and pre-procedural renal failure 4,5 .…”

“…Previous studies reported that the prevalence of CIN after CAG or PCI procedures range from 2%-15% and can reach up to 50% in patients under high risk such as diabetes mellitus (DM) and pre-procedural renal failure 4,5 . CIN was previously defined as an increase in baseline serum creatinine level (Cr) 25% or 0.5 mg/ dL within 48-72 h after PCI [1][2][3] . Although, the physiological mechanisms of CIN are not certain, oxidative stress, inflammation, renal medullary hypoxia, and negative effects of contrast media are supposed to be the underlying physiological mechanisms [6][7][8][9] .…”

“…Although, the physiological mechanisms of CIN are not certain, oxidative stress, inflammation, renal medullary hypoxia, and negative effects of contrast media are supposed to be the underlying physiological mechanisms [6][7][8][9] . The previous studies determined that age, DM, heart failure, anemia, chronic (preexisting) kidney disease, hypoalbuminemia, metabolic syndrome, overuse of high osmolar contrast medium, and peripheral vascular disease are predictors of CIN [1][2][3][4][5][6][7][8][9] . Also, relation between body mass index (BMI) and development of CIN were evaluated in different studies and the results are confounding [1][2][3][4] .…”

“…The previous studies determined that age, DM, heart failure, anemia, chronic (preexisting) kidney disease, hypoalbuminemia, metabolic syndrome, overuse of high osmolar contrast medium, and peripheral vascular disease are predictors of CIN [1][2][3][4][5][6][7][8][9] . Also, relation between body mass index (BMI) and development of CIN were evaluated in different studies and the results are confounding [1][2][3][4] . The clinical impact of malnutrition has been shown in chronic kidney disease and cardiovascular diseases [5][6][7][8] .…”