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Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention.

Liu Y, Liu YH, Chen JY, Tan N, Zhou YL, Duan CY, Yu DQ, Xie NJ, Li HL, Chen PY - Medicine (Baltimore) (2015)

Bottom Line: Thirty-nine patients (3.8%) developed CIN.There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001).After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology (YL, J-yC, NT, Y-lZ, D-qY, N-jX, H-lL), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; Department of cardiology, Guangdong General Hospital, Southern Medical University (Y-hL); and Department of Biostatistics (C-yD, P-yC), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

ABSTRACT
The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI). We prospectively enrolled 1020 consecutive elderly patients (age ≥65 years) with relative normal renal function (baseline serum creatinine <1.5 mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression. Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic = 0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016). A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function.

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(A) Relationship between the contrast volume to creatinine clearance ratio and the percentage of patients with CIN after cardiac catheterization (P < 0.001, overall and for the trend). (B) Relationship between CIN and in-hospital death or MACEs (all P < 0.001). CIN = contrast-induced nephropathy, MACE = major adverse clinical event.
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Figure 1: (A) Relationship between the contrast volume to creatinine clearance ratio and the percentage of patients with CIN after cardiac catheterization (P < 0.001, overall and for the trend). (B) Relationship between CIN and in-hospital death or MACEs (all P < 0.001). CIN = contrast-induced nephropathy, MACE = major adverse clinical event.

Mentions: The patients with a high V/CrCl ratio were more likely to develop CIN, including 5 patients (1.96%) in Q1, 6 (2.35%) in Q2, 6 (2.35%) in Q3, and 22 (8.63%) in Q4 (P < 0.001) (Figure 1A). The patients with an increasing V/CrCl ratio experienced a higher rate of IABP (P = 0.001). However, the incidence of in-hospital death, stroke, acute heart failure, and the need for renal replacement were not significantly different among the different V/CrCl ratio quartiles.


Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention.

Liu Y, Liu YH, Chen JY, Tan N, Zhou YL, Duan CY, Yu DQ, Xie NJ, Li HL, Chen PY - Medicine (Baltimore) (2015)

(A) Relationship between the contrast volume to creatinine clearance ratio and the percentage of patients with CIN after cardiac catheterization (P < 0.001, overall and for the trend). (B) Relationship between CIN and in-hospital death or MACEs (all P < 0.001). CIN = contrast-induced nephropathy, MACE = major adverse clinical event.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553999&req=5

Figure 1: (A) Relationship between the contrast volume to creatinine clearance ratio and the percentage of patients with CIN after cardiac catheterization (P < 0.001, overall and for the trend). (B) Relationship between CIN and in-hospital death or MACEs (all P < 0.001). CIN = contrast-induced nephropathy, MACE = major adverse clinical event.
Mentions: The patients with a high V/CrCl ratio were more likely to develop CIN, including 5 patients (1.96%) in Q1, 6 (2.35%) in Q2, 6 (2.35%) in Q3, and 22 (8.63%) in Q4 (P < 0.001) (Figure 1A). The patients with an increasing V/CrCl ratio experienced a higher rate of IABP (P = 0.001). However, the incidence of in-hospital death, stroke, acute heart failure, and the need for renal replacement were not significantly different among the different V/CrCl ratio quartiles.

Bottom Line: Thirty-nine patients (3.8%) developed CIN.There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001).After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology (YL, J-yC, NT, Y-lZ, D-qY, N-jX, H-lL), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; Department of cardiology, Guangdong General Hospital, Southern Medical University (Y-hL); and Department of Biostatistics (C-yD, P-yC), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

ABSTRACT
The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI). We prospectively enrolled 1020 consecutive elderly patients (age ≥65 years) with relative normal renal function (baseline serum creatinine <1.5 mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression. Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic = 0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016). A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function.

Show MeSH
Related in: MedlinePlus