Korean Circulation Journal

  • 제41권5호
  • /
  • Pages.265-271
  • /
  • 2011
  • /
  • 1738-5520(pISSN)
  • /
  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
권호 표지
DOI QR코드

DOI QR Code

Determination of Safe Contrast Media Dosage to Estimated Glomerular Filtration Rate Ratios to Avoid Contrast-Induced Nephropathy After Elective Percutaneous Coronary Intervention

  • Yoon, Hyuck-Jun (Devision of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Hur, Seung-Ho (Devision of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center)
  • 발행 : 2011.05.30
⟨ 이전 논문 다음 논문 ⟩

초록

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 nephropathy 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 ${\geq}$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.

키워드

참고문헌

  1. Murphy SW, Barrett BJ, Parfrey PS. Contrast nephropathy. J Am Soc Nephrol 2000;11:177-82.
  2. Porter GA. Contrast-associated nephropathy: presentation, pathophysiology and management. Miner Electrolyte Metab 1994;20:232-43.
  3. McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW. Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 1997;103:368-75. https://doi.org/10.1016/S0002-9343(97)00150-2
  4. McCullough PA, Adam A, Becker CR, et al. Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol 2006;98:5K-13K.
  5. Rihal CS, Textor SC, Grill DE, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 2002;105:2259-64. https://doi.org/10.1161/01.CIR.0000016043.87291.33
  6. Dangas G, Iakovou I, Nikolsky E, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 2005;95: 13-9. https://doi.org/10.1016/j.amjcard.2004.08.056
  7. Morcos SK. Contrast media-induced nephrotoxicity: questions and answers. Br J Radiol 1998;71:357-65.
  8. Lee KH, Lee SR, Kang KP, et al. Periprocedural hemoglobin drop and contrast-induced nephropathy in percutaneous coronary intervention patients. Korean Circ J 2010;40:68-73. https://doi.org/10.4070/kcj.2010.40.2.68
  9. Namgung J, Doh JH, Lee SY, Hur WS, Park SW, Lee WR. Effect of N-acetylcysteine in prevention of contrast-induced nephropathy after coronary angiography. Korean Circ J 2005;35:696-701.
  10. Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC. Meta-an-alysis: effectiveness of drugs for preventing contrast-induced neph-ropathy. Ann Intern Med 2008;148:284-94. https://doi.org/10.7326/0003-4819-148-4-200802190-00007
  11. Cigarroa RG, Lange RA, Williams RH, Hillis LD. Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 1989;86:649-52. https://doi.org/10.1016/0002-9343(89)90437-3
  12. Altmann D, Zwas D, Spatz A, et al. Use of the contrast volume estimated creatinine clearance ratio to predict renal failure after angiogra-phy. J Interv Cardiol 1997;10:113-9. https://doi.org/10.1111/j.1540-8183.1997.tb00018.x
  13. Bartholomew BA, Harjai KJ, Dukkipati S, et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol 2004;93:1515-9. https://doi.org/10.1016/j.amjcard.2004.03.008
  14. Laskey WK, Jenkins C, Selzer F, et al. Volume-to-creatinine clearance ratio: a pharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention. J Am Coll Cardiol 2007;50:584-90. https://doi.org/10.1016/j.jacc.2007.03.058
  15. Nyman U, Almen T, Aspelin P, Hellstrom M, Kristiansson M, Sterner G. Contrast-medium-Induced nephropathy correlated to the ratio between dose in gram iodine and estimated GFR in ml/min. Acta Radiol 2005;46:830-42. https://doi.org/10.1080/02841850500335051
  16. Kim U, Kim YJ, Lee WJ, et al. The estimated glomerular filtration rate with using the Mayo clinic quardratic equation as a new predictor for developing contrast induced nephropathy in patients with angina pectoris. Korean Circ J 2008;38:301-4. https://doi.org/10.4070/kcj.2008.38.6.301
  17. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol 2008;51:1419-28. https://doi.org/10.1016/j.jacc.2007.12.035
  18. Levey AS, Greene T, Schluchter MD, et al. Glomerular filtration rate measurements in clinical trials. Modification of Diet in Renal Disease Study Group and the Diabetes Control and Complications Trial Research Group. J Am Soc Nephrol 1993;4:1159-71.
  19. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-70. https://doi.org/10.7326/0003-4819-130-6-199903160-00002
  20. Frennby B, Sterner G. Contrast media as markers of GFR. Eur Radiol 2002;12:475-84. https://doi.org/10.1007/s003300100864
  21. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41. https://doi.org/10.1159/000180580
  22. Nyman U, Bjork J, Aspelin P, Marenzi G. Contrast medium dose-to-GFR ratio: a measure of systemic exposure to predict contrast-induc-ed nephropathy after percutaneous coronary intervention. Acta Radiol 2008;49:658-67. https://doi.org/10.1080/02841850802050762
  23. Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology 1993;188: 171-8.
  24. Liss P, Persson PB, Hansell P, Lagerqvist B. Renal failure in 57,925 patients undergoing coronary procedures using iso-osmolar or low-osmolar contrast media. Kidney Int 2006;70:1811-7. https://doi.org/10.1038/sj.ki.5001887
  25. Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 2003;348:491-9. https://doi.org/10.1056/NEJMoa021833
  26. Davidson CJ, Laskey WK, Hermiller JB, et al. Randomized trial of contrast media utilization in high-risk PTCA: the COURT trial. Circulation 2000;101:2172-7. https://doi.org/10.1161/01.CIR.101.18.2172
  27. Carraro M, Malalan F, Antonione R, et al. Effects of a dimeric vs a monomeric nonionic contrast medium on renal function in patients with mild to moderate renal insufficiency: a double-blind, randomized clinical trial. Eur Radiol 1998;8:144-7. https://doi.org/10.1007/s003300050356

피인용 문헌

  1. Contrast induced exacerbation of renal dysfunction in the advanced chronic kidney disease vol.28, pp.2, 2011, https://doi.org/10.1007/s12928-012-0143-y
  2. Contrast-induced acute kidney injury: how much contrast is safe? vol.28, pp.6, 2013, https://doi.org/10.1093/ndt/gfs602
  3. Use of the contrast volume or grams of iodine-to-creatinine clearance ratio to predict mortality after percutaneous coronary intervention vol.165, pp.4, 2013, https://doi.org/10.1016/j.ahj.2012.12.017
  4. Contrast-Induced Nephropathy : An “All or None” Phenomenon? vol.66, pp.6, 2011, https://doi.org/10.1177/0003319714550309
  5. Contrast-Induced Acute Kidney Injury: An Update vol.30, pp.2, 2016, https://doi.org/10.1007/s10557-015-6635-0
  6. Novel diagnostic and imaging techniques in endovascular iliac artery procedures vol.18, pp.7, 2011, https://doi.org/10.1080/14779072.2020.1780916
  7. Use of Contrast Medium Volume to Guide Prophylactic Hydration to Prevent Acute Kidney Injury After Contrast Administration: A Meta-Analysis vol.215, pp.1, 2020, https://doi.org/10.2214/ajr.19.22325
  8. Refining Safe Contrast Limits for Preventing Acute Kidney Injury After Percutaneous Coronary Intervention vol.10, pp.1, 2021, https://doi.org/10.1161/jaha.120.018890