Use of the Contrast Volume to Estimated Creatinine Clearance Ratio to Predict Renal Failure After Angiography

Abstract

Little data exists regarding the relationship between the volume of radiographic contrast infused and the risk of contrast nephropathy for individual patients based on specific patient characteristics. Because the likelihood of renal failure is increased when there is preexisting azotemia or when larger volumes of contrast are used, it was hypothesized that the contrast volume:estimated creatinine clearance ratio would serve as a predictor of nephropathy following cardiac angiography. A retrospective analysis was performed of 152 high risk patients whose baseline serum creatinine concentration was >2.0 mg/dL or who received ± 300 ce of contrast. Nephropathy, defined as in increase in serum creatinine of > 1.0 mg/dL within 48 hours, occurred in 11 patients (7%). The contrast volume: creatinine clearance ratio was > 6.0 in 64% of patients who developed nephropathy and 31% of patients who did not (P < 0.05). The contrast volume:creatinine clearance ratio was then studied prospectively in 250 consecutive patients. The risk of nephropathy was 61% for patients with a ratio > 6.0, but only 1% otherwise (P < 0.01). This ratio can be used to calculate an upper limit for contrast volume and might reduce the chance of renal failure.

Volume-to-Creatinine Clearance Ratio

“…Contrast volume/CrCl was used in a retrospective analysis of 152 patients with chronic kidney disease (defined as a baseline creatinine Ͼ2.0 mg/dl) and was found to be predictive of CAN (defined as an increase in creatinine of 1.0 mg/dl) at a cutoff value of 6.0 (28). This cutoff was then used prospectively in 250 consecutive patients (creatinine of 0.3 to 5.8 mg/dl) and found to have a sensitivity of 79% and specificity of 97% for predicting CAN (28). These data are not strictly comparable with those reported herein because of differences in the number of patients studied, the number with chronic kidney disease, and the definition and overall incidence of CAN.…”

The Efficacy of the Cystatin C Based Glomerular Filtration Rate in the Estimation of Safe Contrast Media Volume

“…In the retrospective study regarding high-risk patients (sCr >2.0 mg/dL or CM volume >300 mL), the cut off value of CM volume/eGFR (by Cockcroft-Gault equation) was defines as 6.0 10). Another study conducted in 3179 unselected patients undergoing PCI reported that CM volume/eGFR (by MDRD equation) of <3.27 might be a useful indicator in determining the CM volume which might be considered safe from the CIN 11). Previously, we also reported safe CM volume using grams of iodine per eGFR (g-I/eGFR) at a level of 1.42 27)…”

The contrast medium volume to estimated glomerular filtration rate ratio as a predictor of contrast-induced nephropathy after primary percutaneous coronary intervention

“…The cutoff value of the contrast dose to CrCl ratio indicating a risk for CIN was 6.0 [24]. The serum Cr level does not increase until the GFR has decreased by 50% or more [25].…”