title: The association between contrast dose and renal complications post PCI across the continuum of procedural estimated risk.
abstract: BACKGROUND
  Prior studies have proposed to restrict the contrast volume (CV) to <3x calculated creatinine clearance (CCC), to prevent contrast induced nephropathy (CIN) post percutaneous coronary interventions (PCI). The predictive value of this algorithm for CIN and therefore the benefit of this approach in high risk patients has been questioned. The aim of our study was to assess the association between contrast dose and the occurrence of CIN in patients at varying predicted risks of CIN and baseline CCC following contemporary PCI.
  
  
  METHODS
  Consecutive patients undergoing PCI between 2010-2012 were included. Baseline risk of CIN was calculated using a previously validated risk tool. High contrast dose was defined as CV/CCC >3. Likelihood ratio tests were used to evaluate whether the effect of a high contrast dose on the risk of CIN and nephropathy requiring dialysis (NRD) varied across the spectrum of baseline predicted risk.
  
  
  RESULTS
  Of the 82,120 PCI included in our analysis, 25% were performed using a high contrast dose. Patients treated with a high compared with a low contrast dose were at increased risks of CIN and NRD, throughout the entire range of baseline predicted risk and CCC in our population. The effect size of a high contrast dose on risks of both outcomes varied significantly with baseline predicted CIN risk and CCC (CIN p = 0.004, NRD p<0.001 for adding interactions), and was largest for patients with predicted CIN risk <10% and pre-existing chronic kidney disease.
  
  
  CONCLUSIONS
  The use of a high contrast dose is associated with increased risks of CIN and NRD across the continuum of baseline predicted risk and CCC. Efforts to reduce contrast dose may therefore be effective in preventing renal complications in all patients undergoing PCI.
authors.affiliation: Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Kooiman
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Milan
authors.initials: M
authors.lastname: Seth
authors.affiliation: Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Share
authors.affiliation: Beaumont Hospital, Royal Oak, Michigan, United States of America.
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000368:Aged; D000465:Algorithms; D001835:Body Weight; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D054059:Coronary Occlusion / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000473:pathology; D016013:Likelihood Functions; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D003287:Contrast Media; D003404:Creatinine