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Safe Limits of Contrast Media for Contrast-Induced Nephropathy: A Multicenter Prospective Cohort Study

Zhiqiang Nie1,2, Yong Liu3, Chao Wang1

  • 1Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Frontiers in Medicine
|September 7, 2021
PubMed

Insights

The ratio of contrast volume to glomerular filtration rate (CV/GFR), specifically using the CKD-EPI equation (CV/CKD-EPI), can predict contrast-induced nephropathy (CIN) in patients undergoing coronary angiography or PCI. A CV/CKD-EPI ratio of 1.78 or higher significantly increases CIN risk.

Area of Science:

  • Nephrology
  • Cardiology
  • Radiology

Background:

  • Contrast-induced nephropathy (CIN) is a risk following contrast media procedures.
  • Safe contrast volume (CV) limits for preventing CIN are not well-established.
  • Existing studies on CV limits are primarily single-center.

Purpose of the Study:

  • To investigate the association between contrast volume-to-glomerular filtration rate (CV/GFR) ratio and CIN risk.
  • To identify a reliable predictor for CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).

Main Methods:

  • A prospective, multicenter, observational cohort study (REICIN) included 4,254 patients from 2013-2016.
  • The ratio of contrast volume to glomerular filtration rate (CV/GFR) was calculated using five primary GFR equations.
  • The performance of different CV/GFR ratios in predicting CIN was evaluated.

Main Results:

  • 1.7% of patients developed CIN, with a median CV/CKD-EPI ratio of 2.16.
  • The CV/CKD-EPI ratio demonstrated superior model fit, discrimination (AUC=0.736), calibration, and conciseness.
  • A CV/CKD-EPI ratio ≥1.78 was significantly associated with increased CIN risk (aOR=4.64, p<0.001).

Conclusions:

  • The CV/CKD-EPI ratio is a high-performing predictor of CIN in patients undergoing CAG or PCI.
  • A threshold of CV/CKD-EPI ≥1.78 can serve as a reliable and convenient CIN risk indicator.
  • Pre-procedural calculation of CV/GFR is recommended to guide contrast volume administration and mitigate CIN risk.

Keywords:
contrast-induced nephropathycoronary angiographyglomerular filtration ratepercutaneous coronary interventionsafe limits

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