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Outcomes of ultra-low contrast percutaneous coronary intervention in patients with advanced chronic kidney disease
Richard Sekerak1, Johanna Ben-Ami Lerner1, Christopher Garnett1
1Columbia University Medical Center, New York, New York, USA.
Insights
Ultra-low contrast percutaneous coronary intervention (PCI) is safe for patients with advanced chronic kidney disease (CKD). This approach minimizes contrast-induced nephropathy risk and supports renal function preservation, potentially aiding renal transplantation.
Area of Science:
- Nephrology
- Cardiology
- Interventional Radiology
Background:
- Coronary procedures in chronic kidney disease (CKD) patients increase risks of contrast-induced nephropathy (CIN) and renal replacement therapy (RRT).
- Evaluating novel strategies to mitigate these risks is crucial for patient outcomes.
Purpose of the Study:
- To assess the feasibility and 1-year outcomes of ultra-low contrast percutaneous coronary intervention (PCI) in patients with advanced CKD.
- To characterize the safety and efficacy of reduced contrast media during PCI in this high-risk population.
Main Methods:
- Retrospective analysis of 100 patients with CKD stages 3b-5 (eGFR <45 mL/min/1.73m²), not on RRT, undergoing ultra-low contrast PCI (<30 mL contrast).
- Primary outcomes included changes in estimated glomerular filtration rate (eGFR) and 1-year rates of death, RRT, and major adverse cardiac events (MACE).
Main Results:
- A median of 8 mL contrast was used, with no significant difference in pre- and post-procedure eGFR (p=0.84).
- At 1 year, 8% of patients died, 11% required RRT, and 33% experienced MACE. 39% of those evaluated for transplant received one.
- The median contrast-to-eGFR ratio was 0.37, indicating efficient contrast utilization.
Conclusions:
- Ultra-low contrast PCI is feasible and safe in advanced CKD patients, with minimal need for peri-procedural RRT.
- This technique may preserve renal function, potentially benefiting patients awaiting renal transplantation.
- Further research should explore long-term benefits and optimal contrast thresholds.
Background:
Coronary angiography and percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD) is associated with increased risk of contrast induced nephropathy (CIN) and requirement for renal replacement therapy (RRT).
Objectives:
We aimed to evaluate our single center experience of ultra-low contrast PCI in patients with CKD and to characterize 1 year outcomes.
Methods:
We performed a retrospective analysis of ultra-low contrast PCI at our institution between 2016 and 2022. Patients with CKD3b-5 (eGFR <45 mL/min/1.73m2), not on RRT who underwent ultra-low contrast PCI ( < 30 mL of contrast during PCI) were included. Primary outcomes included change in eGFR post-procedurally, and death, RRT requirement, and major adverse cardiac events (MACE) at 1 year follow-up.
Results:
One hundred patients were included in the study. The median age was 67 years old and 28% were female. The median baseline eGFR was 21.5 mL/min/1.73m2 (IQR 14.08-32.0 mL/min/1.73m2). A median of 8.0 mL (IQR 0-15 mL) of contrast was used during PCI. Median contrast use to eGFR ratio was 0.37 (IQR 0-0.59). There was no significant difference between pre-and postprocedure eGFR (p = 0.84). At 1 year, 8% of patients died, 11% required RRT and 33% experienced MACE. The average time of RRT initiation was 7 months post-PCI. Forty-four patients were undergoing renal transplant evaluation, of which 17 (39%) received a transplant.
Conclusions:
In patients with advanced CKD, ultra-low contrast PCI is feasible and safe with minimal need for peri-procedural RRT. Moreover, ultra-low contrast PCI may allow for preservation of renal function in anticipation of renal transplantation.
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