Volume of contrast to creatinine clearance ratio: a novel pharmacokinetic index for prediction of contrast induced nephropathy in stage three chronic kidney disease patients undergoing coronary angioplasty
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 8
Abstract
Objective: The aim of the study was to identify the optimal ‘Volume of contrast to Creatinine Clearance ratio’ {V/CrCl} for prediction of contrast induced nephropathy {CIN} in stage III chronic kidney disease {CKD} patients undergoing coronary angioplasty. Methods: This was a prospective observational study where stage III CKD patients, with an estimated glomerular filtration rate (eGFR) between 30-60 ml/mt undergoing elective percutaneous coronary intervention {PCI} over a period of 15 months were evaluated prospectively for the development of CIN. Receiver-operator characteristic {ROC} curves were used to identify the optimal sensitivity and specificity for the observed range of V/CrCl. The predictive value of V/CrCl for the risk of CIN was assessed using multivariable logistic regression. Results: 100 stage III CKD patients underwent PCI during the study period. The incidence of CIN was 29 %. Based on the ‘Volume of contrast /Creatinine clearance ratio {V/CrCl} the quartiles of the V/CrCl ratio for all the patients were as follows: quartile (Q1) (<3.45, n=25); Q2 (3.45-4.28, n=25); Q3 (4.28-5.31, n=25); and Q4 (>5.31, n=25). The receiver-operator characteristic curve analysis indicated that a V/CrCl ratio of 4 was a fair discriminator for the development of CIN {C-statistic 0.69}. After adjusting for other known predictors of CIN, a V/CrCl ratio of 4 was found to be significantly associated with the development of CIN {OR: 2.849, 95 % CI: 0.972-8.363, p=0.05} Conclusion: A V/CrCl ratio of > 4 was a significant and independent predictor of CIN in stage III CKD patients undergoing PCI.
Authors and Affiliations
Dr Dilip Mazhavancheri Narayanan MD. DM
Keywords
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