Renal Function-Based Contrast Dosing to Define Safe Limits of Radiographic Contrast Media in Patients Undergoing Percutaneous Coronary Interventions

Aug 15, 2011
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Authors:
Gurm HS, Dixon SR, Smith DE, et al., on behalf of the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) Registry.
Citation:
J Am Coll Cardiol 2011;58:907-914.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the association between calculated creatinine clearance (CCC)-based contrast dose and renal complications in patients undergoing percutaneous coronary interventions (PCI)?

Methods:

The investigators assessed the association between CCC-based contrast dose and the risk of contrast-induced nephropathy (CIN) and need for in-hospital dialysis in 58,957 patients undergoing PCI and enrolled in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry in 2007-2008. Patients receiving dialysis at the time of the procedure were excluded. They calculated the odds of CIN and nephropathy requiring dialysis (NRD) at contrast volume (CV)/CCC ratio of 2, 2.5, and 3 in unadjusted and fully adjusted hierarchical models.

Results:

The risk of CIN and NRD was directly associated with increasing contrast volume adjusted for renal function. The risk for CIN and NRD approached significance when the ratio of contrast dose/CCC exceeded 2 (adjusted odds ratio [OR] for CIN, 1.16; 95% confidence interval [CI], 0.98-1.37; adjusted OR for NRD, 1.72; 95% CI, 0.9-3.27) and was dramatically elevated in patients exceeding a contrast to CCC ratio of 3 (adjusted OR for CIN, 1.46; 95% CI, 1.27-1.66; adjusted OR for NRD, 1.89; 95% CI, 1.21-2.94).

Conclusions:

The authors concluded that this study supports the need for minimizing contrast dose in patients with renal dysfunction.

Perspective:

This study corroborates previous observations that the contrast volume/CC ratio is a simple tool that can help guide contrast dosing in patients undergoing PCI, and supports the need for minimizing contrast dose in patients undergoing invasive cardiac procedures. Furthermore, it adds practical guidance by suggesting that a contrast dose on the basis of CC with a planned contrast volume restricted to <2x CC and not to exceed 3x CC appears prudent in reducing the risk of CIN and NRD.

Keywords: Contrast Media, Renal Dialysis, Michigan, Kidney Diseases, Percutaneous Coronary Intervention


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