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Contrast volume to creatinine clearance ratio – a strong predictor of contrast induced nephropathy in patients undergoing percutaneous intervention
Session:
SESSÃO DE POSTERS 07 - DOENÇAS CARDIOVASCULARES - LESÃO RENAL AGUDA E INFLAMAÇÃO
Speaker:
Francisco Rodrigues Dos Santos
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Francisco Rodrigues Dos Santos; Gonçalo Ferreira; João Gouveia Fiuza; Mariana Duarte Almeida; Vanda Devesa Neto; Oliver Kungel; António Costa; Inês Fiuza Pires
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Background:</span></strong> Contrast-induced nephropathy (CIN) is a common complication following percutaneous coronary intervention (PCI) and it is associated with a worse prognosis. There are predictive factors of CIN, such as chronic kidney disease, but it can also affect individuals with normal renal function. In this study, we aim to assess if a ratio with volume of iodinated contrast (Vc) and creatinine clearance (Clcr) can predict the occurrence of CIN in patients with normal renal function.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Methods:</span></strong> We developed a retrospective analysis of patients who underwent elective or urgent PCI between January 1, 2019, and May 31, 2024. Patients with creatinine clearance (ClCr) >60 mL/min, calculated using the Cockroft-Gault formula, and pre procedure serum creatinine (SCr) <= 1.2 mg/dL were included. According to literature, a Vc/Clcr ratio ≥ 4 was considered high, therefore, patients were divided into two groups accordingly. CIN was defined as an increase in SCr of ≥ 0.5 mg/dL or 0.25% increase from basal levels and the relationship between Vc/Clcr and CIN was then analysed, using the <span style="background-color:white"><span style="color:black">Chi-square and Mann-Whitney U tests</span></span> and multivariate logistic regression.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="color:black">Results:</span></span></strong> <span style="color:#1c1e21">487 patients were included, 59.1% (n=289) were men, with a mean age of 66.62 ±10.33 years and 31,4% (n=153) diabetic. Mean ClCr was 91.92 ml/min/1.73m² ± 28.26 and an average dose of iodinated contrast used of 208,61 ± 2.48 ml.</span> <span style="color:black">9% (n=44) patients developed CIN.</span><span style="color:#1c1e21"> Vc/Clcr ratio >4 was observed</span><span style="color:#1c1e21"> in 14.8% (n=</span><span style="color:#1c1e21">72) patients, </span><span style="color:black">41.7% of diabetics vs 29.6% in the Vc/Clcr<4 group, 33.3% with anaemia vs 21.0% in the group with the lower contrast dose.</span> <span style="background-color:white"><span style="color:black">After analysis with </span></span><span style="background-color:white"><span style="color:black">Chi-square test</span></span><span style="color:#1c1e21">, a statistically significant association between the presence of CIN and Vc/Clcr >4 appeared (χ² = 41.666, p < 0.001), with patients with CIN showing a markedly higher prevalence of Vc/Clcr >4 (47.7%) compared to those without CIN (11.5%). </span><span style="color:black">Multivariate logistic regression analysis supported </span><span style="color:#1c1e21">the previous results (OR: 7.018, 95% CI: 3.629–13.573, p = 0.001), </span><span style="color:black">These findings thus support an increased risk of CIN in this patient group, independent of other variables.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="color:#1c1e21">Conclusion:</span></span></strong><span style="color:#1c1e21"> This study highlights the likely impact of the volume of iodinated contrast used during percutaneous coronary intervention on the development of CIN, further demonstrating a real risk of this complication even in patients with good renal function at admission. It also emphasizes the need to adopt preventive strategies, particularly minimizing the volume of contrast used to the necessary minimum. </span></span></span></span></p>
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