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Safety margin of minimized contrast volume during percutaneous coronary intervention in patients with chronic kidney disease

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Abstract

Maximum allowable contrast dose (MACD) calculated as body weight × 5/serum creatinine has been a standard contrast dye volume (CV) used to decrease contrast-induced acute kidney injury. Recent advances in intravascular ultrasound-guided percutaneous coronary intervention (PCI) can dramatically minimize CV. The safe threshold when using an extremely low-dose CV is unknown. This study was designed as a multicenter, retrospective study of chronic kidney disease (CKD) patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2 undergoing elective PCI. We divided the patients into three groups according to following criteria: (1) low dose, CV/eGFR ratio <1.0; (2) medium dose, CV/eGFR ratio ≥1 and <MACD; and (3) high dose, CV ≥MACD. A total of 100 patients were enrolled. Average age was 74 ± 8 years, 64 % were male and 48 % were diabetic. Mean baseline eGFR was 22.8 ± 6.0 ml/min/1.73 m2. CV in the three groups was 15 ± 6 ml (n = 18), 69 ± 39 ml (n = 47) and 224 ± 99 ml (n = 35), respectively. The incidences of CI-AKI were 0, 11 and 23 %, respectively (p = 0.02). All-cause death or introduction of maintenance hemodialysis at 1 year was 0, 13.8 and 31 %, respectively (p = 0.01). Extreme reduction of CV to a CV/eGFR ratio <1.0 may reduce CI-AKI and achieve better clinical outcomes following PCI in patients with severe CKD.

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Acknowledgments

This study was partly supported by a grant from Daiichi-Sankyo Pharmaceutical Company. We thank Ms Sachiko Yajima (Tokai University) for data management.

Conflict of interest

None of the authors have a conflict of interest regarding this study.

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Authors and Affiliations

  1. Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan

    Nobuhiko Ogata & Yuji Ikari

  2. Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan

    Mamoru Nanasato

  3. Department of Cardiology, Nozaki Tokushukai Hospital, Daito, Japan

    Masaaki Okutsu

  4. Heart Center, Nagoya Tokushukai General Hospital, Kasugai, Japan

    Ryosuke Kametani

  5. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Mitsuru Abe

  6. Department of Cardiology, The Jikei University, Katsushika Medical Center, Tokyo, Japan

    Yoshiki Uehara

  7. Department of Advanced Cardiovascular Therapeutics, Osaka University School of Medicine, Suita, Japan

    Satoru Sumitsuji

Authors
  1. Nobuhiko Ogata
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  2. Yuji Ikari
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  3. Mamoru Nanasato
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  4. Masaaki Okutsu
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  5. Ryosuke Kametani
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  6. Mitsuru Abe
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  7. Yoshiki Uehara
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  8. Satoru Sumitsuji
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Corresponding author

Correspondence to Yuji Ikari.

Additional information

On behalf of the Minicon Registry Investigators.

UMIN-CRT: UMIN0000008436.

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Ogata, N., Ikari, Y., Nanasato, M. et al. Safety margin of minimized contrast volume during percutaneous coronary intervention in patients with chronic kidney disease. Cardiovasc Interv and Ther 29, 209–215 (2014). https://doi.org/10.1007/s12928-014-0245-9

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  • DOI: https://doi.org/10.1007/s12928-014-0245-9

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