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The Association between Contrast Dose and Renal Complications Post PCI across the Continuum of Procedural Estimated Risk

BACKGROUND: Prior studies have proposed to restrict the contrast volume (CV) to <3x calculated creatinine clearance (CCC), to prevent contrast induced nephropathy (CIN) post percutaneous coronary interventions (PCI). The predictive value of this algorithm for CIN and therefore the benefit of this...

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Autores principales: Kooiman, Judith, Seth, Milan, Share, David, Dixon, Simon, Gurm, Hitinder S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953074/
https://www.ncbi.nlm.nih.gov/pubmed/24625555
http://dx.doi.org/10.1371/journal.pone.0090233
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author Kooiman, Judith
Seth, Milan
Share, David
Dixon, Simon
Gurm, Hitinder S.
author_facet Kooiman, Judith
Seth, Milan
Share, David
Dixon, Simon
Gurm, Hitinder S.
author_sort Kooiman, Judith
collection PubMed
description BACKGROUND: Prior studies have proposed to restrict the contrast volume (CV) to <3x calculated creatinine clearance (CCC), to prevent contrast induced nephropathy (CIN) post percutaneous coronary interventions (PCI). The predictive value of this algorithm for CIN and therefore the benefit of this approach in high risk patients has been questioned. The aim of our study was to assess the association between contrast dose and the occurrence of CIN in patients at varying predicted risks of CIN and baseline CCC following contemporary PCI. METHODS: Consecutive patients undergoing PCI between 2010–2012 were included. Baseline risk of CIN was calculated using a previously validated risk tool. High contrast dose was defined as CV/CCC >3. Likelihood ratio tests were used to evaluate whether the effect of a high contrast dose on the risk of CIN and nephropathy requiring dialysis (NRD) varied across the spectrum of baseline predicted risk. RESULTS: Of the 82,120 PCI included in our analysis, 25% were performed using a high contrast dose. Patients treated with a high compared with a low contrast dose were at increased risks of CIN and NRD, throughout the entire range of baseline predicted risk and CCC in our population. The effect size of a high contrast dose on risks of both outcomes varied significantly with baseline predicted CIN risk and CCC (CIN p = 0.004, NRD p<0.001 for adding interactions), and was largest for patients with predicted CIN risk <10% and pre-existing chronic kidney disease. CONCLUSIONS: The use of a high contrast dose is associated with increased risks of CIN and NRD across the continuum of baseline predicted risk and CCC. Efforts to reduce contrast dose may therefore be effective in preventing renal complications in all patients undergoing PCI.
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spelling pubmed-39530742014-03-18 The Association between Contrast Dose and Renal Complications Post PCI across the Continuum of Procedural Estimated Risk Kooiman, Judith Seth, Milan Share, David Dixon, Simon Gurm, Hitinder S. PLoS One Research Article BACKGROUND: Prior studies have proposed to restrict the contrast volume (CV) to <3x calculated creatinine clearance (CCC), to prevent contrast induced nephropathy (CIN) post percutaneous coronary interventions (PCI). The predictive value of this algorithm for CIN and therefore the benefit of this approach in high risk patients has been questioned. The aim of our study was to assess the association between contrast dose and the occurrence of CIN in patients at varying predicted risks of CIN and baseline CCC following contemporary PCI. METHODS: Consecutive patients undergoing PCI between 2010–2012 were included. Baseline risk of CIN was calculated using a previously validated risk tool. High contrast dose was defined as CV/CCC >3. Likelihood ratio tests were used to evaluate whether the effect of a high contrast dose on the risk of CIN and nephropathy requiring dialysis (NRD) varied across the spectrum of baseline predicted risk. RESULTS: Of the 82,120 PCI included in our analysis, 25% were performed using a high contrast dose. Patients treated with a high compared with a low contrast dose were at increased risks of CIN and NRD, throughout the entire range of baseline predicted risk and CCC in our population. The effect size of a high contrast dose on risks of both outcomes varied significantly with baseline predicted CIN risk and CCC (CIN p = 0.004, NRD p<0.001 for adding interactions), and was largest for patients with predicted CIN risk <10% and pre-existing chronic kidney disease. CONCLUSIONS: The use of a high contrast dose is associated with increased risks of CIN and NRD across the continuum of baseline predicted risk and CCC. Efforts to reduce contrast dose may therefore be effective in preventing renal complications in all patients undergoing PCI. Public Library of Science 2014-03-13 /pmc/articles/PMC3953074/ /pubmed/24625555 http://dx.doi.org/10.1371/journal.pone.0090233 Text en © 2014 Kooiman et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Kooiman, Judith
Seth, Milan
Share, David
Dixon, Simon
Gurm, Hitinder S.
The Association between Contrast Dose and Renal Complications Post PCI across the Continuum of Procedural Estimated Risk
title The Association between Contrast Dose and Renal Complications Post PCI across the Continuum of Procedural Estimated Risk
title_full The Association between Contrast Dose and Renal Complications Post PCI across the Continuum of Procedural Estimated Risk
title_fullStr The Association between Contrast Dose and Renal Complications Post PCI across the Continuum of Procedural Estimated Risk
title_full_unstemmed The Association between Contrast Dose and Renal Complications Post PCI across the Continuum of Procedural Estimated Risk
title_short The Association between Contrast Dose and Renal Complications Post PCI across the Continuum of Procedural Estimated Risk
title_sort association between contrast dose and renal complications post pci across the continuum of procedural estimated risk
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953074/
https://www.ncbi.nlm.nih.gov/pubmed/24625555
http://dx.doi.org/10.1371/journal.pone.0090233
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