Clinical Research
Interventional Cardiology
Renal Function-Based Contrast Dosing to Define Safe Limits of Radiographic Contrast Media in Patients Undergoing Percutaneous Coronary Interventions

https://doi.org/10.1016/j.jacc.2011.05.023Get rights and content
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Objectives

The aim of this study was to evaluate the association between calculated creatinine clearance (CCC)-based contrast dose and renal complications in patients undergoing percutaneous coronary interventions (PCI).

Background

Excess volumes of contrast media are associated with renal complications in patients undergoing cardiac procedures. Because contrast media are excreted by the kidney, we hypothesized that a dose estimation on the basis of CCC would provide a simple strategy to define a safe dose of contrast media.

Methods

We assessed the association between CCC-based contrast dose and the risk of contrast-induced nephropathy (CIN) and need for in-hospital dialysis in 58,957 patients undergoing PCI and enrolled in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry from 2007 to 2008. Patients receiving dialysis at the time of the procedure were excluded.

Results

The risk of CIN and nephropathy requiring dialysis (NRD) was directly associated with increasing contrast volume adjusted for renal function. The risk for CIN and NRD approached significance when the ratio of contrast dose/CCC exceeded 2 (adjusted odds ratio [OR] for CIN: 1.16, 95% confidence interval [CI]: 0.98 to 1.37, adjusted OR for NRD: 1.72, 95% CI: 0.9 to 3.27) and was dramatically elevated in patients exceeding a contrast to CCC ratio of 3 (adjusted OR for CIN: 1.46, 95% CI: 1.27 to 1.66, adjusted OR for NRD: 1.89, 95% CI: 1.21 to 2.94).

Conclusions

Our study supports the need for minimizing contrast dose in patients with renal dysfunction. A contrast dose on the basis of estimated renal function with a planned contrast volume restricted to less than thrice and preferably twice the CCC might be valuable in reducing the risk of CIN and NRD.

Key Words

contrast media
percutaneous coronary intervention
renal function

Abbreviations and Acronyms

CCC
calculated creatinine clearance
CI
confidence interval
CIN
contrast-induced nephropathy
CV
contrast volume
GFR
glomerular filtration rate
MACD
maximal acceptable contrast dose
MDRD
Modification of Diet in Renal Disease
NRD
nephropathy requiring dialysis
OR
odds ratio
PCI
percutaneous coronary intervention

Cited by (0)

The BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry is funded by Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network, with initial registry development funded by the BCBSM Foundation. The sponsor had no role in study design, analysis, or the decision to present or publish these findings. Dr. Gurm has received research funding from BCBSM and the National Institute of Health. Dr. Dixon has received research support from Abbott Vascular, Abiomed, and Infraredx. Dr. Share is employed by BCBSM. Dr. LaLonde is on the speakers' bureau for Abbott Vascular, Gilead Sciences, Pfizer, and GlaxoSmithKline; and has received research support from Medtronic. Dr. Moscucci has received research support from BCBSM in the past. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.