Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Background-Age, estimated glomerular renal function (eGFR), and ejection fraction are preprocedural predictors of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention. The effect of renal function-adjusted contrast volume (CV) remains not totally explored, and a threshold has not yet been established. Methods and Results-Logistic regression and receiver-operating characteristic curve analyses were used to assess whether CV/eGFR was an independent predictor of CI-AKI. The increased discriminative value of CV/eGFR over the preprocedural model based on age, eGFR, and ejection fraction was examined using the net reclassification improvement analysis. Of 470 patients enrolled, we observed 25 (5.3%) cases of CI-AKI. Patients with CI-AKI had received a higher renal function-adjusted CV (CV/eGFR 3.62 versus 1.96; P<0.001), and CI-AKI incidence was higher (15%; P<0.001) in patients in the highest quartile of CV/eGFR, corresponding to the cutoff indicated by the receiver-operating characteristic curve (>2.5; area under the curve, 0.77). At multivariable analysis, CV/eGFR above the cutoff (odds ratio, 5.57; P=0.002) remained an independent predictor of CI-AKI. The model with CV/eGFR demonstrated a statistically significantly net reclassification improvement of 0.23 (P=0.021) over the baseline preprocedural model, largely driven by a correct decrease in risk estimates for patients not experiencing CI-AKI, with a likelihood ratio χ 2 of 5.973 (P=0.029). Conclusions-CV remains a key risk factor for CI-AKI after primary percutaneous coronary intervention and our study supports the need for minimizing CV, independently from baseline preprocedural risk. A CV restricted to no more than twice and a half the baseline eGFR might be valuable in reducing the risk of CI-AKI. (Circ Cardiovasc Interv. 2014;7:465-472.)Key Words: acute kidney injury ◼ balloon coronary angioplasty ◼ contrast media adverse effects ◼ myocardial infarction

Short-term rosuvastatin therapy prevents contrast-induced acute kidney injury in female patients with diabetes and chronic kidney disease: a subgroup analysis of the TRACK-D study

“…This gender-based analysis of TRACK-D population showed that females with diabetes and CKD were at higher risk of CIAKI compared to their male counterparts and were benefit from short-term rosuvastatin treatment during peri-operative period of angiography or percutaneous intervention. Previous studies have suggested that diabetes mellitus, CKD, advanced age, severe heart failure and a high volume of contrast medium were independent predictors of CIAKI (13). Other studies have demonstrated that female gender, with or without CKD, is an independent predictor of CIAKI development after PCI procedure.…”

Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety

“…Ejection fraction is also a predictor of CI-AKI. 28 Both simple and complex risk scores can be calculated for patients before a procedure to estimate risk for CI-AKI. 35,36 Hydration During the Procedure…”

“…11 During this time, the prolonged exposure of the renal tubules to the contrast agent propagates direct cellular injury, inducing tubular apoptosis ( Figure 1). 12 Measures to prevent CI-AKI have been studied, including the use of physiological saline for volume expansion, 13 intravenous versus oral volume expansion, [14][15][16][17][18][19] physiological saline versus sodium bicarbonate intravenous prophylaxis, 20 use of medications such as N-acetylcysteine [21][22][23] and ascorbic acid, 24 withholding nephrotoxic medications before the procedure with contrast material and after the dose of contrast material is administered, 3 type of contrast medium used, 25 use of volumes of contrast material based on initial estimated glomerular filtration rate (eGFR), [26][27][28] and postprocedure hydration. Such studies indicated the following: Use of physiological saline alone protected better against renal insufficiency than did physiological saline with mannitol or furosemide.…”

Utility of cone-beam computed tomography in the assessment of the porto-spleno-mesenteric venous system

“…Estimated glomerular renal function is a useful predictor of CIN and can be used to adjust the volume of contrast agent administered (37). The risk of CIN can be reduced if the contrast volume is restricted to no more than 2.5 times the baseline estimated glomerular renal function (52).…”