Korean Circ J.  2013 Sep;43(9):622-627. 10.4070/kcj.2013.43.9.622.

The Efficacy of the Cystatin C Based Glomerular Filtration Rate in the Estimation of Safe Contrast Media Volume

• Yoon HJ
• Kim H
• Lee JP
• Choi SW
• Cho HO
• Shin HW
• Park HS
• Cho YK
• Nam CW
• Hur SH
• Kim YN
• Kim KB

• KMID: 2224818
• DOI: http://doi.org/10.4070/kcj.2013.43.9.622

Abstract

BACKGROUND AND OBJECTIVES
The risk of contrast-induced nephropathy (CIN) is significantly influenced by baseline renal function and the amount of contrast media (CM). We evaluated the usefulness of the cystatin C (CyC) based estimated glomerular filtration rate (eGFR(CyC)) in the prediction of CIN and to determine the safe CM dosage.
SUBJECTS AND METHODS
We prospectively enrolled a total of 723 patients who received percutaneous coronary intervention (PCI) and investigated the clinical factors associated with the development of CIN. Renal function was calculated as eGFR(CyC) and a modified diet in the renal disease (MDRD) equation, respectively. Systemic exposure of CM was calculated as CM volume to eGFR ratio. We conducted a regression analysis to evaluate the predictive role of CM volume to eGFR(CyC) for the risk of CIN.
RESULTS
The incidence of CIN was 4.0% (29/723). The patients with CIN had a lower hemoglobin level, decreased renal function, and a higher CyC value, and had greater CM exposure. Through multivariate regression analyses, hemoglobin {odds ratio (OR) 0.743, p=0.032}, CM volume/eGFR(CyC) (OR 1.697, p=0.006) and CM volume/MDRD (OR 2.275, p<0.001) were found to be independent predictors for CIN. In the receiver operating characteristic curve analysis, fair discrimination for CIN was found at a CM volume/eGFR(CyC) level of 4.493 (C-statics=0.814), and at this value, the sensitivity and specificity were 79.3% and 80.0%, respectively.
CONCLUSION
Both the CM volume/MDRD and CM volume/eGFR(CyC) method would be simple, useful indicators for determining the safe CM-dose based on eGFR value before PCI. However, there was no significantly different predictive value between creatinine and CyC based GFR estimations.

Keyword

Contrast media; Cystatin C; Glomerular filtration rate; Acute kidney injury

MeSH Terms

Acute Kidney Injury
Contrast Media
Creatinine
Cystatin C
Diet
Discrimination (Psychology)
Glomerular Filtration Rate
Hemoglobins
Humans
Incidence
Percutaneous Coronary Intervention
Prospective Studies
ROC Curve
Sensitivity and Specificity
Contrast Media
Creatinine
Cystatin C
Hemoglobins

Figure

• 

  Fig. 1 Incidence of CIN according to the quartiles of CM volume/eGFRCyC. Incidence of CIN is significantly higher in the 4th quartile. CyC: cystatin C, eGFR: estimated glomerular filtration rate.

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  Fig. 2 Receiver operating characteristic curve for the prediction of CIN using CM volume/eGFRCyC and CM volume/MDRD. The area under the curve for predicting CIN of CM volume/eGFRCyC was 0.814 and CM volume/MDRD was 0.772, respectively. CIN: contrast induced nephropathy, CyC: cystatin C, MDRD: equation of modification of diet on renal disease study group.

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