title: Safe limits of contrast vary with hydration volume for prevention of contrast-induced nephropathy after coronary angiography among patients with a relatively low risk of contrast-induced nephropathy.
abstract: BACKGROUND
  Few studies have investigated the safe limits of contrast to prevent contrast-induced nephropathy (CIN) based on hydration data. We aimed to investigate the relative safe maximum contrast volume adjusted for hydration volume in a population with a relatively low risk of CIN.
  
  
  RESULTS
  The ratios of contrast volume-to-creatinine clearance (V/CrCl) and hydration volume to body weight (HV/W) were determined in patients undergoing cardiac catheterization. Receiver-operator characteristic curve analysis based on the maximum Youden index was used to identify the optimal cutoff for V/CrCl in all patients and in HV/W subgroups. Eighty-six of 3273 (2.6%) patients with mean CrCl 71.89±27.02 mL/min developed CIN. Receiver-operator characteristic curve analysis indicated that a V/CrCl ratio of 2.44 was a fair discriminator for CIN in all patients (sensitivity, 73.3%; specificity, 70.4%). After adjustment for other confounders, V/CrCl >2.44 continued to be significantly associated with CIN (adjusted odds ratio, 4.12; P<0.001) and the risk of death (adjusted hazard ratio, 2.62; P<0.001). The mean HV/W was 12.18±7.40. We divided the patients into 2 groups (HV/W ≤12 and >12 mL/kg). The best cutoff value for V/CrCl was 1.87 (sensitivity, 67.9%; specificity, 64.4%; adjusted odds ratio, 3.24; P=0.011) in the insufficient hydration subgroup (HV/W, ≤12 mL/kg; CIN, 1.32%) and 2.93 (sensitivity, 69.0%; specificity, 65.0%; adjusted odds ratio, 3.04; P=0.004) in the sufficient hydration subgroup (HV/W, >12 mL/kg; CIN, 5.00%).
  
  
  CONCLUSIONS
  The V/CrCl ratio adjusted for HV/W may be a more reliable predictor of CIN and even long-term outcomes after cardiac catheterization. We also found a higher best cutoff value for V/CrCl to predict CIN in patients with a relatively sufficient hydration status, which may be beneficial during decision-making about contrast dose limits in relatively low-risk patients with different hydration statuses.
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.). chenjiyandr@126.com tanning100@126.com chenpy99@126.com.
authors.forename: Ji-Yan
authors.initials: JY
authors.lastname: Chen
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.). chenjiyandr@126.com tanning100@126.com chenpy99@126.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Tan
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Ying-Ling
authors.initials: YL
authors.lastname: Zhou
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Dan-Qing
authors.initials: DQ
authors.lastname: Yu
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Zhu-Jun
authors.initials: ZJ
authors.lastname: Chen
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: He
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Yuan-Hui
authors.initials: YH
authors.lastname: Liu
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Jian-Fang
authors.initials: JF
authors.lastname: Luo
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Huang
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Guang
authors.initials: G
authors.lastname: Li
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Peng-Cheng
authors.initials: PC
authors.lastname: He
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Jun-Qing
authors.initials: JQ
authors.lastname: Yang
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Nian-Jin
authors.initials: NJ
authors.lastname: Xie
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Xiao-Qi
authors.initials: XQ
authors.lastname: Liu
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Da-Hao
authors.initials: DH
authors.lastname: Yang
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Shui-Jin
authors.initials: SJ
authors.lastname: Huang
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.lastname: Piao-Ye
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Hua-Long
authors.initials: HL
authors.lastname: Li
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Peng
authors.initials: P
authors.lastname: Ran
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.).
authors.forename: Chong-Yang
authors.initials: CY
authors.lastname: Duan
authors.affiliation: From the Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (Y.L., J.-Y.C., N.T., Y.-L.Z., D.-Q.Y., Z.-J.C., Y.-T.H., Y.-H.L., J.-F.L., W.-H.H., G.L., P.-C.H., J.-Q.Y., N.-J.X., X.-Q.L., D.-H.Y., S.-J.H., P.-Y., H.-L.L., P.R., C.-Y.D.); and Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (C.-Y.D., P.-Y.C.). chenjiyandr@126.com tanning100@126.com chenpy99@126.com.
authors.forename: Ping-Yan
authors.initials: PY
authors.lastname: Chen
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014882:Water-Electrolyte Balance
chemical_list: D003287:Contrast Media
keywords: diabetes mellitus; glomerular filtration rate; percutaneous coronary intervention