Related Experiment Video
Updated: Sep 15, 2025
Ischemia-reperfusion Model of Acute Kidney Injury and Post Injury Fibrosis in Mice
Published on: August 9, 2013
Left-Digit Bias in Serum Creatinine Levels and Contrast Administration: A Nationwide Cohort Study Using a Japanese
Takahiro Suzuki1,2, Yuichiro Mori3, John A Spertus4,5
1Department of Cardiovascular Medicine St. Luke's International Hospital Tokyo Japan.
Insights
Physicians may be influenced by left-digit bias when administering contrast during percutaneous coronary intervention (PCI), potentially impacting acute kidney injury (AKI) prevention. This cognitive bias in interpreting serum creatinine levels affects contrast volume decisions.
Area of Science:
- Cardiology
- Nephrology
- Medical Decision Making
Background:
- Minimizing contrast volume is crucial for preventing acute kidney injury (AKI) after percutaneous coronary intervention (PCI).
- Left-digit bias, a cognitive tendency to overemphasize the leftmost digit of a number, may influence clinical decisions.
- Interpreting serum creatinine levels, a key factor in AKI risk assessment, could be subject to this bias, affecting contrast administration during PCI.
Purpose of the Study:
- To investigate the impact of left-digit bias in serum creatinine interpretation on contrast volume administration in patients undergoing PCI.
- To determine if cognitive biases, specifically left-digit bias, influence contrast volume decisions independent of established AKI risk scores.
Main Methods:
- Analysis of a Japanese nationwide prospective multicenter registry of patients undergoing PCI from January 2018 to December 2022.
- Assessment of left-digit bias by comparing PCI contrast volumes at specific serum creatinine thresholds (e.g., 1.0 mg/dL, 2.0 mg/dL).
- Calculation of AKI risks using a validated risk scoring system to compare with observed contrast volume decisions.
Main Results:
- A total of 735,696 PCI procedures were analyzed, with a median contrast volume of 117 mL.
- A significant decrease in average contrast volume was observed when baseline creatinine levels crossed integer thresholds (1.0 mg/dL and 2.0 mg/dL), indicating left-digit bias.
- Contrast volume adjustments were less sensitive to calculated AKI risk scores than to creatinine values at integer thresholds, suggesting a prioritization of perceived creatinine levels over formal risk stratification.
Conclusions:
- Left-digit bias in serum creatinine interpretation demonstrably affects contrast volume administration during PCI.
- Current practices may lead to suboptimal contrast use for AKI prevention, as decisions appear driven by cognitive bias rather than comprehensive risk assessment.
- Implementing formal risk stratification protocols is essential to optimize contrast volume and mitigate AKI risk in PCI patients.
Background:
Contemporary quality initiatives emphasize minimizing contrast volume as a key modifiable factor to prevent acute kidney injury (AKI) following percutaneous coronary intervention (PCI). Left-digit bias is a cognitive bias where the leftmost digit of a number disproportionately influences decisions. This bias may unintentionally affect contrast administration when interpreting laboratory values like serum creatinine. Therefore, we aim to assess the impact of left-digit bias in serum creatinine level on contrast volume in PCI.
Methods:
We analyzed patients undergoing PCI between January 2018 and December 2022 using the Japanese nationwide prospective multicenter registry. The primary outcome was PCI contrast volume. Left-digit bias was assessed by comparing contrast volume differences at specific creatinine thresholds (eg, 1.0 mg/dL and 2.0 mg/dL). AKI risks were calculated by a validated risk scoring system.
Results:
Among 735 696 PCI procedures, the median contrast volume was 117 mL (interquartile range 85-157 mL). Analysis of average contrast volume revealed a sharp decrease at baseline creatinine levels above versus less than 1 mg/dL (mean difference, 2.2 mL [95% CI, 1.6-2.8]) and 2 mg/dL (4.7 [95% CI, 1.6-7.8]) but not at 3 mg/dL (-2.0 [95% CI, -10.0 to 6.0]). Despite differences at integer thresholds of creatinine, minimal variation across AKI risk levels suggests operators prioritize creatinine values over predicted AKI risk.
Conclusions:
Our study provides valuable insights into contemporary trends in contrast volume for PCI and identifies left-digit bias in creatinine interpretation affecting contrast administration. Formal risk stratification is essential to optimize contrast use for AKI prevention.
More Related Videos
04:41Digital PCR for Quantifying Circulating MicroRNAs in Acute Myocardial Infarction and Cardiovascular Disease
Published on: July 3, 2018
06:02Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:24Serum Studies: Renal Function Tests
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:08Renal Drug Clearance: Comparison Between Renal Excretion Methods
Renal clearance is often associated with the renal glomerular filtration rate (GFR), which represents the rate at which plasma is filtered through the glomeruli in the kidney. When drug reabsorption is minimal and there is no active secretion, renal clearance is closely related to the...
01:28Cardiac Catheterization I: Pre-Procedure Overview