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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 - Korean Circ J (2011)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Devision of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.

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 ≥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.

No MeSH data available.


Related in: MedlinePlus

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.
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Figure 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.

Mentions: As shown in Table 2, upon univariate logistic regression analysis, age, usage of intraaortic balloon pump, hypertension, LVEF, Hb level, and g-I/eGFR were significantly correlated with the development of CIN. Although a history of diabetes was not within the range of statistical significance, it had a close correlation with the development of CIN (p=0.051). On multivariate analysis, only the ratio of g-I/eGFR remained as a significant independent risk factors for the development of CIN (g-I/eGFR, OR 9.786, 95% CI 3.40-28.15, p<0.001) (Table 2). In the analysis using g-I/eGFR ratio, quartiles showed a gradual increase in the incidence of CIN in quartiles III and IV. On the other hand, in quartiles I and II, the incidence of CIN were significantly lower than those of quartiles III and IV (Fig. 1).


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 - Korean Circ J (2011)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116105&req=5

Figure 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.
Mentions: As shown in Table 2, upon univariate logistic regression analysis, age, usage of intraaortic balloon pump, hypertension, LVEF, Hb level, and g-I/eGFR were significantly correlated with the development of CIN. Although a history of diabetes was not within the range of statistical significance, it had a close correlation with the development of CIN (p=0.051). On multivariate analysis, only the ratio of g-I/eGFR remained as a significant independent risk factors for the development of CIN (g-I/eGFR, OR 9.786, 95% CI 3.40-28.15, p<0.001) (Table 2). In the analysis using g-I/eGFR ratio, quartiles showed a gradual increase in the incidence of CIN in quartiles III and IV. On the other hand, in quartiles I and II, the incidence of CIN were significantly lower than those of quartiles III and IV (Fig. 1).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Devision of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.

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 ≥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.

No MeSH data available.


Related in: MedlinePlus