Table 1.
Previously Published Studies of Safe Contrast Limits for Preventing CA‐AKI
| Author | Patient Cohort | CA‐AKI Definition | Contrast Limit | Performance of Limit |
|---|---|---|---|---|
| Cigarroa 1989 21 | 115 patients with renal dysfunction (creatinine >1.8) undergoing diagnostic coronary angiography | Creatinine increase >1 mg/dL by 5 d | CV <5*Weightt/Creatinine | CA‐AKI in 2% of patients below limit. CA‐AKI in 38% of patients above limit |
| Marenzi 2009 25 | 561 patients with STEMI undergoing PCI | Creatinine increase > 25% by 72 h | CV <5*Weight/Creatinine | CA‐AKI in 2.8% of patients below limit; CA‐AKI in 13% of patients above limit |
| Laskey 2007 26 | 3179 patients undergoing PCI | Creatinine increase >0.5 mg/dL from 24 to 48 h | CV <3.7*CrCl | CV/CrCl ROC curve had C‐statistic of 0.69 for predicting CA‐AKI |
| Gurm 2011 22 | 58 957 patients undergoing PCI | Creatinine increase >0.5 mg/dL by 1 wk | CV <2*CrCl | CV/CrCl ROC curve had C‐statistic of 0.67 for predicting CA‐AKI |
| Mager 2011 27 | 871 patients with STEMI undergoing PCI | Creatinine increase >0.5 mg/dL or 25% by 48 h | CV < 3.7*CrCl | CV/CrCl >3.7 had odds ratio of 3.87 for CA‐AKI |
| Ando 2014 28 | 535 patients with STEMI undergoing PCI | Creatinine increase > 0.5 mg/dL or 25% by 72 h | CV <2.5*CrCl | CV/CrCl ROC curve had C‐statistic of 0.77 for predicting CA‐AKI |
| Ogata 2014 29 | 100 patients undergoing elective PCI with CrCl <30 | Creatinine increase >0.5 mg/dL or 25% by 48 h | CV <1*CrCl | CA‐AKI in 0% below the limit compared with 11% for CV >2*CrCl but <5*Weight/Creatinine |
| Liu 2015 30 | 3273 patients undergoing coronary angiography or PCI | Creatinine increase >0.5 mg/dL from 48 to 72 h |
CV <2.44*CrCl, CV <1.87*CrCl if low hydration CV <2.93*CrCl if high hydration |
CV/CrCl ROC curve had C‐statistic of 0.78 for predicting CA‐AKI. C‐statistics of 0.74, 0.73 for low and high hydration thresholds |
| Liu 2015 30 | 1020 patients >65 years old with creatinine <1.5 mg/dL undergoing PCI | Creatinine increase >0.5 mg/dL from 48 to 72 h | CV <2.74*CrCl | CV/CrCl ROC curve had C‐statistic of 0.68 for predicting CA‐AKI |
| Nyman 2008 19 | 391 patients with STEMI undergoing PCI | Creatinine increase >44.2 μmol/L | Contrast iodine (g) < CrCl | CA‐AKI in 3% of patients below limit. CA‐AKI in 25% of patients above limit |
| Yoon 2011 20 | 226 patients undergoing elective PCI | Creatinine increase >0.5 mg/dL or 25% from 48 to 72 h | Contrast iodine (g) < 1.42*CrCl | Contrast iodine (g)/CrCl ROC curve had C‐statistic of 0.87 for predicting CA‐AKI |
CA‐AKI indicates contrast‐associated acute kidney injury, CrCl, Creatinine clearance; CV, contrast volume; PCI, percutaneous coronary intervention; ROC, receiver operating characteristic; and STEMI, ST‐segment–elevation myocardial infarction.