Zahler D, Rozenfeld KL, Merdler I, Peri Y, Shacham Y: Contrast Volume to Glomerular Filtration Ratio and Acute Kidney Injury among ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention. Cardiorenal Med DOI 10.1159/000504534
Radio-contrast media volume may have an important influence on the risk of contrast-associated acute kidney injury (AKI). Zahler et al. have carried out a retrospective, observational (and uncontrolled) study to determine if the risk of AKI is associated with the ratio of contrast volume administered to the pre-procedure estimated glomerular filtration rate (eGFR) in subjects undergoing primary percutaneous intervention following an acute myocardial infarction. A total of 419 subjects were included. Iodixanol (a non-ionic, iso-osmolar preparation) was used in all subjects. AKI was defined by the KDIGO criteria.
Out of 419 subjects, 31 (9%) developed AKI. The contrast volume/eGFR ratio was 2.7 ± 1.2 in those with AKI and 1.9 ± 0.9 in those without AKI. Patients experiencing AKI had a much lower pre-procedure eGFR (56 ± 22 mL/min/1.73 m2) compared to those without AKI (73 ± 18 mL/min/1.73 m2). The areas under the curve (AUC) for the occurrence of AKI pointed to a threshold value of contrast volume/GFR of >2.13, but the C-statistic was rather modest at 0.65 (95% CI 0.56–0.74). A multifactorial logistic regression analysis showed that a contrast volume/eGFR ratio of >2.13 was independently associated with AKI. The study did not assess the influence of concomitant use of statins or renin-angiotensin inhibitors. All patients received 0.9% saline infusions at 1 mL/kg/h for 12 h after contrast exposure.
A prospective validation of the threshold for contrast volume/eGFR is needed, but this study and others suggest that selection of the dosage of contrast volume should take the pre-procedure eGFR into account.
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