Safety margin of minimized contrast volume during percutaneous coronary intervention in patients with chronic kidney disease.
Maximum allowable contrast dose (MACD) calculated as body weight × 5/serum creatinine has been a standard contrast dye volume (CV) used to decrease contrast-induced acute kidney injury. Recent advances in intravascular ultrasound-guided percutaneous coronary intervention (PCI) can dramatically minimize CV. The safe threshold when using an extremely low-dose CV is unknown. This study was designed as a multicenter, retrospective study of chronic kidney disease (CKD) patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m(2) undergoing elective PCI. We divided the patients into three groups according to following criteria: (1) low dose, CV/eGFR ratio <1.0; (2) medium dose, CV/eGFR ratio ≥1 and <MACD; and (3) high dose, CV ≥MACD. A total of 100 patients were enrolled. Average age was 74 ± 8 years, 64 % were male and 48 % were diabetic. Mean baseline eGFR was 22.8 ± 6.0 ml/min/1.73 m(2). CV in the three groups was 15 ± 6 ml (n = 18), 69 ± 39 ml (n = 47) and 224 ± 99 ml (n = 35), respectively. The incidences of CI-AKI were 0, 11 and 23 %, respectively (p = 0.02). All-cause death or introduction of maintenance hemodialysis at 1 year was 0, 13.8 and 31 %, respectively (p = 0.01). Extreme reduction of CV to a CV/eGFR ratio <1.0 may reduce CI-AKI and achieve better clinical outcomes following PCI in patients with severe CKD.
Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan.
Nobuhiko
N
Ogata
Yuji
Y
Ikari
Mamoru
M
Nanasato
Masaaki
M
Okutsu
Ryosuke
R
Kametani
Mitsuru
M
Abe
Yoshiki
Y
Uehara
Satoru
S
Sumitsuji
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods
D003287:Contrast Media