title: Renal function-adjusted contrast volume redefines the baseline estimation of contrast-induced acute kidney injury risk in patients undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  Age, estimated glomerular renal function (eGFR), and ejection fraction are preprocedural predictors of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention. The effect of renal function-adjusted contrast volume (CV) remains not totally explored, and a threshold has not yet been established.
  
  
  RESULTS
  Logistic regression and receiver-operating characteristic curve analyses were used to assess whether CV/eGFR was an independent predictor of CI-AKI. The increased discriminative value of CV/eGFR over the preprocedural model based on age, eGFR, and ejection fraction was examined using the net reclassification improvement analysis. Of 470 patients enrolled, we observed 25 (5.3%) cases of CI-AKI. Patients with CI-AKI had received a higher renal function-adjusted CV (CV/eGFR 3.62 versus 1.96; P<0.001), and CI-AKI incidence was higher (15%; P<0.001) in patients in the highest quartile of CV/eGFR, corresponding to the cutoff indicated by the receiver-operating characteristic curve (>2.5; area under the curve, 0.77). At multivariable analysis, CV/eGFR above the cutoff (odds ratio, 5.57; P=0.002) remained an independent predictor of CI-AKI. The model with CV/eGFR demonstrated a statistically significantly net reclassification improvement of 0.23 (P=0.021) over the baseline preprocedural model, largely driven by a correct decrease in risk estimates for patients not experiencing CI-AKI, with a likelihood ratio χ(2) of 5.973 (P=0.029).
  
  
  CONCLUSIONS
  CV remains a key risk factor for CI-AKI after primary percutaneous coronary intervention and our study supports the need for minimizing CV, independently from baseline preprocedural risk. A CV restricted to no more than twice and a half the baseline eGFR might be valuable in reducing the risk of CI-AKI.
authors.affiliation: From the Department of Medicine and Pharmacology and Azienda Ospedaliera Universitaria Policlinico "G. Martino", University of Messina, Messina, Italy. giuseppeando1975@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Andò
authors.affiliation: From the Department of Medicine and Pharmacology and Azienda Ospedaliera Universitaria Policlinico "G. Martino", University of Messina, Messina, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: de Gregorio
authors.affiliation: From the Department of Medicine and Pharmacology and Azienda Ospedaliera Universitaria Policlinico "G. Martino", University of Messina, Messina, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Morabito
authors.affiliation: From the Department of Medicine and Pharmacology and Azienda Ospedaliera Universitaria Policlinico "G. Martino", University of Messina, Messina, Italy.
authors.forename: Olimpia
authors.initials: O
authors.lastname: Trio
authors.affiliation: From the Department of Medicine and Pharmacology and Azienda Ospedaliera Universitaria Policlinico "G. Martino", University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saporito
authors.affiliation: From the Department of Medicine and Pharmacology and Azienda Ospedaliera Universitaria Policlinico "G. Martino", University of Messina, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000517:prevention & control*; D012306:Risk
chemical_list: D003287:Contrast Media
keywords: acute kidney injury; balloon coronary angioplasty; contrast media adverse effects; myocardial infarction