Contrast Volume/Raw eGFR Ratio for Predicting Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention for Myocardial Infarction

Abstract

Background: Considering that contrast medium is excreted through the whole kidney in a similar manner to drug excretion, the use of raw estimated glomerular filtration rate (eGFR) rather than body surface area (BSA)-normalized eGFR is thought to be more appropriate for evaluating the risk of contrast-induced acute kidney injury (CI-AKI). Methods: This study included 2,189 myocardial infarction patients treated with percutaneous coronary intervention. Logistic regression analysis was performed to identify the independent risk factors. We used receiver-operating characteristic (ROC) curves to compare the ratios of contrast volume (CV) to eGFR with and without BSA normalization in predicting CI-AKI. Results: The area under the curve (AUC) of the ROC curve for the model including all the significant variables such as diabetes mellitus, left ventricular ejection fraction, preprocedural glucose, and the CV/raw modification of diet in renal disease (MDRD) eGFR ratio was 0.768 [95% confidence interval (CI), 0.720-0.816; p < 0.001]. When the CV/raw MDRD eGFR ratio was used as a single risk value, the AUC of the ROC curve was 0.650 (95% CI, 0.590-0.711; p < 0.001). When the CV/MDRD eGFR ratio with BSA normalization ratio was used, the AUC of the ROC curve further decreased to 0.635 (95% CI, 0.574-0.696; p < 0.001). The difference between the two AUCs was significant (p = 0.002). Conclusions: Raw eGFR is a better predictor for CI-AKI than BSA-normalized eGFR.

Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair

“…A large series examining cardiac intervention patients developed similar models with unacceptable discrimination when these two concepts were omitted. 27 Infrarenal endovascular AAA repair occurs frequently enough to provide an adequate cohort for the preceding analyses. Evolving process improvement for infrarenal AAA must guide other aortic procedures, particularly complex AAA repair with branched or fenestrated endografts.…”

Outcomes of Endovascular Aortic Aneurysm Repair in Kidney Transplant Recipients: Results From a National Quality Initiative

“…The current recommendations are to keep the administered contrast to a minimum, which is nonspecific (13,14). Park et al described the use of iodinated contrast:estimated glomerular filtration rate (eGFR) ratio for predicting contrast-induced acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention for myocardial infarction (15), but to date this metric has not been evaluated within the KTR population.…”

Renal function-adjusted contrast medium volume is a major risk factor in the occurrence of acute kidney injury after endovascular aneurysm repair

“…Considering the difference in eGFR between the two groups, renal function-adjusted CV, or the CV/eGFR ratio, was investigated as both a risk factor and a predictive model. Although several studies have used this ratio as a predictor for CA-AKI after percutaneous coronary interventions, [ 11 – 13 , 21 ] it has not been used during the EVAR procedure for AAA; however, one study had previously reported the CV/eGFR ratio as a useful predictor for CA-AKI occurrence after EVAR. [ 22 ]…”

“…In addition, the study in which coronary intervention was performed showed cutoff results in the range of 2.5 to 3.0. [ 11 – 13 , 21 ] Further research is needed to obtain a standard cutoff value and to estimate the optimal dose of contrast agent.…”