Iodine/eGFR is a useful indicator for determining the safe contrast media dosage to avoid contrast-induced nephropathy during coronary angiography

초록

Background: Contrast-induced nephropathy (CIN) has been commonly defined as a sudden, rapid deterioration in renal status after study of iodinated contrast medium (CM) in the absence of any other causes.To avoid the risk of developing contrast-induced nephropathy (CIN), it has been suggested that patients be subjected to a minimal necessary dose of contrast medium (CM-dose). Methods: : The ratio of CM-dose to eGFR in predicting the risks of CIN was assessed and sought to determine the safe level of CM-dose/eGFR in patients undergoing coronary angiography (CA). We enrolled a total of 226 patients and calculated the ratio of CM-dose using grams of iodine (g-I) to eGFR, thus expressing it as g-I/eGFR. Among the CIN patients, those requiring dialysis were also evaluated. Results: Overall, there were 16 cases (7.1%) of CIN. On univariate and multivariate regression analysis, g-I/eGFR alone was found to be an independent predictor for CIN (hazard ratio=10.73, p<0.001). In an receiver operating characteristic analysis, fair discrimination for CIN was found at a g-I/eGFR level of 1.42 (C statics=0.867), and at this value, the sensitivity and specificity were 81.3% and 80%, respectively. Of patients (n=51) with g-I/eGFR 1.42, 23.6% (13/51) and 7.8% (4/51) developed, while those with g-I/eGFR <1.42 (n=171) had a lower incidences of CIN (1.8%, 2/171, p<0.001). Conclusion: G-I/eGFR is a useful indicator for determining the safe CM-dose based on the pre-CA eGFR values. Furthermore, g-I/eGFR might have a close relationship with the development of renal failure requiring dialysis as well as CIN not-requiring dialysis.