Acute Kidney Injury Risk Lower With Ultra-Low Contrast Volume Use

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Use of ultra-low contrast volume during percutaneous coronary intervention was associated with 32% decreased odds of acute kidney injury, investigators report.
Use of ultra-low contrast volume during percutaneous coronary intervention was associated with 32% decreased odds of acute kidney injury, investigators report.

Use of ultra-low contrast volume in patients undergoing percutaneous coronary intervention (PCI) is associated with a significant reduction in the incidence of acute kidney injury (AKI) or need for dialysis, according to investigators.

“It may be prudent to consider this new threshold when performing PCI on patients who are at an increased risk of AKI,” Hitinder S. Gurm, MD, of the University of Michigan in Ann Arbor, and colleagues concluded in Catheterization and Cardiovascular Interventions.

Dr Gurm's team examined the prevalence and outcomes associated with the use of ultra-low contrast volume—defined as less than or equal to patients' estimated creatinine clearance— among 75,393 patients undergoing PCI from July 2014 to June 2017. Ultra-low contrast volume was used in 13% of cases. Compared with patients who received a contrast volume of 1 to 3 times the creatinine clearance, use of ultra-low contrast volume was associated with significant 32% decreased odds of AKI and 66% decreased odds of needing dialysis in adjusted analyses.

Earlier this year, based on the findings from a prospective study, investigators in Israel reported that the use of ultra-low contrast volume in patients with advanced chronic kidney disease undergoing coronary angiographic or PCI is a safe, feasible, and effective way to prevent contrast-induced nephropathy (CIN). The study, published in Nephron Clinical Practice, included 30 patients. The median contrast volume was 13 mL for diagnostic coronary angiography and 26 mL for PCI. The investigators defined CIN as a 25% or greater increase in serum cystatin or creatinine 48 hours following the procedure. At 48 hours post-procedure, 3 patients (10% had a 25% or greater increase in cystatin C, and no patient had a 25% or greater rise in serum creatinine.

Reference

Gurm HS, Seth M, Dixon SR, et al. Contemporary use of and outcomes associated with ultra-low contrast volume in patients undergoing percutaneous coronary interventions. Catheter Cardiovasc Interv. 2018; published online ahead of print.

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