Contrastmediuminduced nephropathy correlated to the ratio between dose in gram iodine and estimated GFR in ml/min
(2005) In Acta Radiologica 46(8). p.830842 Abstract
 Purpose: To suggest a more precise tool when assessing the risk of contrastmediuminduced nephropathy (CIN), i.e. the ratio between contrast medium (CM) dose expressed in grams of iodine (gI) and estimated glomerular filtration rate in ml/min (eGFR; based on equations using serumcreatinine (sCr), weight, height, age, and/or sex), here named Idose/GFR ratio. Material and Methods: A Medline search of published CIN investigations reporting mean eGFR and mean dose of lowosmolality CM (LOCM) identified 10 randomized controlled prophylactic and 2 cohort coronary investigations, and 3 randomized and I cohort computed tomographic (CT) investigation. From the randomized trials, data were collected only from the placebo or control arms, unless... (More)
 Purpose: To suggest a more precise tool when assessing the risk of contrastmediuminduced nephropathy (CIN), i.e. the ratio between contrast medium (CM) dose expressed in grams of iodine (gI) and estimated glomerular filtration rate in ml/min (eGFR; based on equations using serumcreatinine (sCr), weight, height, age, and/or sex), here named Idose/GFR ratio. Material and Methods: A Medline search of published CIN investigations reporting mean eGFR and mean dose of lowosmolality CM (LOCM) identified 10 randomized controlled prophylactic and 2 cohort coronary investigations, and 3 randomized and I cohort computed tomographic (CT) investigation. From the randomized trials, data were collected only from the placebo or control arms, unless there was no significant difference between the control and test groups. The mean Idose/GFR ratio of each study was correlated with the mean frequency of CIN1 (sCr rise >= 44.2 mu mol/l or >= 2025%) and CIN2 (oliguria or requiring dialysis). A maximum dose according to an Idose/GFR ratio = 1 in patients with sCr ranging from 100 to 300 mu mol/l was compared with that of CIGARROA'S formula and with a "European consensus" threshold published by the European Society of Urogenital Radiology, both using sCr alone to predict renal function. MCCULLOUGH'S formula was used to assess the risk of CIN requiring dialysis at an Idose/GFR ratio=1 with LOCM. Results: The coronary investigations revealed a linear correlation with a correlation coefficient between the Idose/GFR ratio and the frequency of CIN1 and CIN2 of 0.91 (P<0.001) and 0.84 (P=0.001), respectively. At a mean Idose/GFR ratio=1, the regression line indicated a 10% risk of CIN1 and a 1% risk of CIN2. At a mean Idose/ GFR ratio=3, the risk of CIN1 and CIN2 increased to about 50% and 15%, respectively. Pooled weighted data from the CT investigations revealed a 12% risk of CIN1 at a mean Idose/GFR ratio = 1.1 and no cases of CIN2. The maximum CM dose according to an Idose/GFR ratio=1 was about 3050% of that of both CIGARROA'S formula and the "European consensus" in elderly lowweight individuals, while it was similar for middleaged individuals weighing about 90 kg. MCCULLOUGH'S formula suggests that there will be an exponentially increasing risk of CIN requiring dialysis, but at an Idose/GFR ratio = 1 and using LOCM it will not exceed 1% until GFR decreases below 30 ml/min in diabetics and below 20 ml/min in nondiabetics. Conclusion: Using the Idose/GFR ratio may be a more expedient way of improving risk assessment of CIN than today's common practice of estimating CM dose from volume alone and renal function from sCr alone. Prospective studies based on individual patient data are encouraged to define the risk of CIN at various Idose/GFR ratios and correlated to type of CM, examination, risk factors, etc. (Less)
Please use this url to cite or link to this publication:
http://lup.lub.lu.se/record/894286
 author
 Nyman, U; Almén, Torsten ^{LU} ; Aspelin, P; Hellstrom, M; Kristiansson, M and Sterner, Gunnar ^{LU}
 organization
 publishing date
 2005
 type
 Contribution to journal
 publication status
 published
 subject
 keywords
 effects of drugs on, function, toxicity, interventional procedures, complications, kidney, failure, contrast media, angiography, computed tomography
 in
 Acta Radiologica
 volume
 46
 issue
 8
 pages
 830  842
 publisher
 John Wiley & Sons
 external identifiers

 wos:000234076700009
 pmid:16392608
 scopus:30844435915
 ISSN
 16000455
 DOI
 10.1080/02841850500335051
 language
 English
 LU publication?
 yes
 id
 ede11b457b5e49fbaab5b046e8a5dd01 (old id 894286)
 date added to LUP
 20080116 15:46:27
 date last changed
 20170924 04:24:26
@article{ede11b457b5e49fbaab5b046e8a5dd01, abstract = {Purpose: To suggest a more precise tool when assessing the risk of contrastmediuminduced nephropathy (CIN), i.e. the ratio between contrast medium (CM) dose expressed in grams of iodine (gI) and estimated glomerular filtration rate in ml/min (eGFR; based on equations using serumcreatinine (sCr), weight, height, age, and/or sex), here named Idose/GFR ratio. Material and Methods: A Medline search of published CIN investigations reporting mean eGFR and mean dose of lowosmolality CM (LOCM) identified 10 randomized controlled prophylactic and 2 cohort coronary investigations, and 3 randomized and I cohort computed tomographic (CT) investigation. From the randomized trials, data were collected only from the placebo or control arms, unless there was no significant difference between the control and test groups. The mean Idose/GFR ratio of each study was correlated with the mean frequency of CIN1 (sCr rise >= 44.2 mu mol/l or >= 2025%) and CIN2 (oliguria or requiring dialysis). A maximum dose according to an Idose/GFR ratio = 1 in patients with sCr ranging from 100 to 300 mu mol/l was compared with that of CIGARROA'S formula and with a "European consensus" threshold published by the European Society of Urogenital Radiology, both using sCr alone to predict renal function. MCCULLOUGH'S formula was used to assess the risk of CIN requiring dialysis at an Idose/GFR ratio=1 with LOCM. Results: The coronary investigations revealed a linear correlation with a correlation coefficient between the Idose/GFR ratio and the frequency of CIN1 and CIN2 of 0.91 (P<0.001) and 0.84 (P=0.001), respectively. At a mean Idose/GFR ratio=1, the regression line indicated a 10% risk of CIN1 and a 1% risk of CIN2. At a mean Idose/ GFR ratio=3, the risk of CIN1 and CIN2 increased to about 50% and 15%, respectively. Pooled weighted data from the CT investigations revealed a 12% risk of CIN1 at a mean Idose/GFR ratio = 1.1 and no cases of CIN2. The maximum CM dose according to an Idose/GFR ratio=1 was about 3050% of that of both CIGARROA'S formula and the "European consensus" in elderly lowweight individuals, while it was similar for middleaged individuals weighing about 90 kg. MCCULLOUGH'S formula suggests that there will be an exponentially increasing risk of CIN requiring dialysis, but at an Idose/GFR ratio = 1 and using LOCM it will not exceed 1% until GFR decreases below 30 ml/min in diabetics and below 20 ml/min in nondiabetics. Conclusion: Using the Idose/GFR ratio may be a more expedient way of improving risk assessment of CIN than today's common practice of estimating CM dose from volume alone and renal function from sCr alone. Prospective studies based on individual patient data are encouraged to define the risk of CIN at various Idose/GFR ratios and correlated to type of CM, examination, risk factors, etc.}, author = {Nyman, U and Almén, Torsten and Aspelin, P and Hellstrom, M and Kristiansson, M and Sterner, Gunnar}, issn = {16000455}, keyword = {effects of drugs on,function,toxicity,interventional procedures,complications,kidney,failure,contrast media,angiography,computed tomography}, language = {eng}, number = {8}, pages = {830842}, publisher = {John Wiley & Sons}, series = {Acta Radiologica}, title = {Contrastmediuminduced nephropathy correlated to the ratio between dose in gram iodine and estimated GFR in ml/min}, url = {http://dx.doi.org/10.1080/02841850500335051}, volume = {46}, year = {2005}, }