Does Safe Dosing of Iodinated Contrast Prevent Contrast-Induced Acute Kidney Injury?

DOI Web Site 被引用文献7件
  • Jeremiah R. Brown
    From the Dartmouth Institute for Health Policy and Clinical Practice (J.R.B., G.T.O., D.J.M.), Dartmouth College, Lebanon, NH; the Section of Cardiology (J.R.B., J.F.R., A.V.K., D.J.M.) and the Section of Nephrology/Hypertension (C.A.B., A.C.S.), Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, VT.
  • John F. Robb
    From the Dartmouth Institute for Health Policy and Clinical Practice (J.R.B., G.T.O., D.J.M.), Dartmouth College, Lebanon, NH; the Section of Cardiology (J.R.B., J.F.R., A.V.K., D.J.M.) and the Section of Nephrology/Hypertension (C.A.B., A.C.S.), Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, VT.
  • Clay A. Block
    From the Dartmouth Institute for Health Policy and Clinical Practice (J.R.B., G.T.O., D.J.M.), Dartmouth College, Lebanon, NH; the Section of Cardiology (J.R.B., J.F.R., A.V.K., D.J.M.) and the Section of Nephrology/Hypertension (C.A.B., A.C.S.), Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, VT.
  • Anton C. Schoolwerth
    From the Dartmouth Institute for Health Policy and Clinical Practice (J.R.B., G.T.O., D.J.M.), Dartmouth College, Lebanon, NH; the Section of Cardiology (J.R.B., J.F.R., A.V.K., D.J.M.) and the Section of Nephrology/Hypertension (C.A.B., A.C.S.), Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, VT.
  • Aaron V. Kaplan
    From the Dartmouth Institute for Health Policy and Clinical Practice (J.R.B., G.T.O., D.J.M.), Dartmouth College, Lebanon, NH; the Section of Cardiology (J.R.B., J.F.R., A.V.K., D.J.M.) and the Section of Nephrology/Hypertension (C.A.B., A.C.S.), Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, VT.
  • Gerald T. O'Connor
    From the Dartmouth Institute for Health Policy and Clinical Practice (J.R.B., G.T.O., D.J.M.), Dartmouth College, Lebanon, NH; the Section of Cardiology (J.R.B., J.F.R., A.V.K., D.J.M.) and the Section of Nephrology/Hypertension (C.A.B., A.C.S.), Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, VT.
  • Richard J. Solomon
    From the Dartmouth Institute for Health Policy and Clinical Practice (J.R.B., G.T.O., D.J.M.), Dartmouth College, Lebanon, NH; the Section of Cardiology (J.R.B., J.F.R., A.V.K., D.J.M.) and the Section of Nephrology/Hypertension (C.A.B., A.C.S.), Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, VT.
  • David J. Malenka
    From the Dartmouth Institute for Health Policy and Clinical Practice (J.R.B., G.T.O., D.J.M.), Dartmouth College, Lebanon, NH; the Section of Cardiology (J.R.B., J.F.R., A.V.K., D.J.M.) and the Section of Nephrology/Hypertension (C.A.B., A.C.S.), Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, VT.

書誌事項

公開日
2010-08
DOI
  • 10.1161/circinterventions.109.910638
公開者
Ovid Technologies (Wolters Kluwer Health)

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説明

<jats:sec> <jats:title>Background—</jats:title> <jats:p>Previous work on contrast-induced acute kidney injury (CI-AKI) has identified contrast volume as a risk factor and suggested that there is a maximum allowable contrast dose (MACD) above which the risk of CI-AKI is markedly increased. We hypothesized that there is a relationship between contrast volume and CI-AKI and that there might be reason to track incremental contrast volumes above and below the MACD limit.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> Consecutive patients undergoing percutaneous coronary intervention (PCI) were prospectively enrolled from 2000 to 2008 (n=10 065). Patients on dialysis before PCI were excluded (n=155). MACD was defined as (5 mL×body weight [kg])/baseline serum creatinine [mg/dL]) and divided into categories in which 1.0 reflects the MACD limit: ≤MACD ratios (<0.5, 0.5 to 0.75, and 0.75 to 1.0) and >MACD (1.0 to 1.5, 1.5 to 2.0, and >2.0). CI-AKI was defined as a ≥0.3 (mg/dL) or ≥50% increase in serum creatinine from baseline or new dialysis. Multivariable regression was conducted to evaluate the effect of exceeding the MACD on CI-AKI. Twenty percent of patients exceeded the MACD. Risk-adjusted CI-AKI increased by an average of 45% for each category exceeding the MACD (odds ratio, 1.45; 95% confidence interval, 1.29 to 1.62) Adjusted odds ratios for each category exceeding the MACD were 1.60 (95% confidence interval, 1.29 to 1.97), 2.02 (95% confidence interval, 1.45 to 2.81), and 2.94 (95% confidence interval, 1.93 to 4.48). CI-AKI for contrast dose <MACD showed no statistical difference ( <jats:italic>P</jats:italic> =0.5). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Contrast volume is a key risk factor for CI-AKI and matters the most in the highest-risk patient. The incremental use of contrast beyond the MACD is associated with an increased risk of CI-AKI.</jats:p> </jats:sec>

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