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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

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 Authors Dr Sanjai Pattu Valappil MD.DM.DNB, Dr Praveen Velappan MD.DM, Dr Sunitha Viswanathan MD.DM.FESC.FSCAI, Dr Alummoottil George Koshy MD.DM.FESC.FSCAI.FACC.FRCP, Dr Prabha Nini Gupta MD.DM.FSCAI, Dr Radhakrishnan Vallikkattu Velayudhan MD.DM.FESC. FACC, Dr Mathew Iype MD.DNB.DM.DNB, Dr Dilip Mazhavancheri Narayanan MD.DM Department of Cardiology, Government Medical College, Thiruvananthapuram 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.