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Personalized contrast agent dosing to prevent contrast induced nephropathy in high risk populations in Guangdong,
Minqi Liao1, Yanhua Yang1, Yan Chen2
1Department of Cardiology, Dongguan People's Hospital (the Tenth Affiliated Hospital of Southern Medical University), Dongguan, 523050, Guangdong, China.
Insights
Contrast media dosage significantly increases contrast-induced nephropathy (CIN) risk, especially above 140ml. Personalized dose management is crucial for high-risk patients, including those with hypertension and diabetes, to prevent kidney injury.
Area of Science:
- Nephrology
- Radiology
- Cardiology
Background:
- Contrast-induced nephropathy (CIN) is acute kidney injury developing within 72 hours of contrast media administration.
- Existing risk stratification models for CIN lack precision, and the interplay of risk factors is not fully understood.
Purpose of the Study:
- To investigate the association between contrast media dosage and CIN occurrence.
- To identify high-risk patient groups and assess the impact of dosage on CIN risk.
Main Methods:
- Retrospective, observational cohort study of 12,376 patients undergoing percutaneous coronary intervention (PCI) or computed tomography angiography (CTA).
- Data collected on demographic and clinical characteristics, with CIN occurrence as the primary outcome.
- Statistical analysis including adjusted odds ratios (OR) to determine risk associations.
Main Results:
- Contrast media dosage was positively associated with CIN risk (OR 1.007 per SD increase).
- Doses exceeding 140ml significantly elevated CIN risk (adjusted OR 3.27).
- Hypertensive and diabetic patients showed increased risk at doses >140ml, highlighting subgroup vulnerabilities.
Conclusions:
- Contrast media dosage is a critical factor in CIN development.
- Personalized dosage management and individualized risk assessment are essential for mitigating CIN risk, particularly in high-risk populations.
- Optimizing contrast media doses can improve patient outcomes and reduce the incidence of CIN.
Abstract:
Contrast-induced nephropathy (CIN) is an acute kidney injury manifests within 72 h post-administration of contrast media, excluding other kidney-damage etiologies. Despite the recognition of CIN, the complex interplay among high-risk factors remains poorly understood, and precision in the existing risk stratification models is lacking. This retrospective, observational cohort study included patients who underwent percutaneous coronary intervention (PCI) or computed tomography angiography (CTA) at four hospitals in Guangdong, China, between 2010 and 2018. Demographic and clinical characteristics of the patients of prognostic interest were collected. The main outcome was CIN occurrence. In total 12,376 patients were included in the final data analysis. Contrast media dosage was positively associated with CIN risk, with an adjusted odds ratio (OR) of 1.007 for each standard deviation increase in dosage. Doses above 140 ml significantly increased CIN risk (adjusted OR = 3.27). Notably, hypertensive and diabetic patients experienced greater risks at doses > 140 ml. Subgroup analyses underscored the importance of personalized dosage management. This study highlights the critical need for dosage management to mitigate CIN risk, particularly in high-risk patients. Individualized risk assessment and dose optimization strategies are essential to minimize the risk of CIN development and improve patient outcomes.
